Hi, Cindy and Alan,
Alan S <loralgtweightandcarbs@[EMAIL PROTECTED]
> wrote:
> On Fri, 29 Aug 2008 07:13:54 -0500, Cindy Wells
> <lcwells8892@[EMAIL PROTECTED]
> wrote:
>>http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0003087
>>(the authors are German so I suspect the patient recruitment was in that
>>area)
>>They started with patients with an A1c around 7 and on oral meds only.
Then
>>they compared patients testing once a week with those testing ~4 times a
>>week with the tests before dinner and one test before lunch. Both groups
>>maintained an A1c around 7.
>>I think those of us who have come to m.h.d. will want better A1c's and
use
>>SMBG to gain a different set of data and make some lifestyle
adjustments.
>>Cindy Wells
> If it wasn't deadly serious we would think this is a joke:
> "Patients with T2D treated with oral antidiabetic drugs were
> randomized to two groups: either one SMBG (low) or four SMBG
> (high) per week."
> Alan M and I disagree on the need for testing, ....
Hey, where's the fun in arguing with people you agree with? :-)
> .... but Alan, if
> you are reading this, could you confirm that test strips are
> subsidised for diabetics in Germany?
Sort of. As a diabetic here, you get prescribed (at "nominal" cost) the
testing strips that you need. Most people pay into a health fund, the
contribution being determined only by income and cir***stances (so it's
sort of a tax, really). "Subsidised" isn't quite the right expression.
"Flat rate" would be nearer. People have sometimes had trouble being
prescribed enough strips.
> Four SMBG per week is high? In that case Jennifer's advice
> would be seen as obsessively extreme, using up two or three
> month's worth of strips in a week.
> One to add to my bibliography of abysmal SMBG studies.
I have to agree with you here, Alan. (Wheee!!!) They don't even say
whether the subjects, or some of them, or any of them, had been doing
BS testing before the study. And they suppress im****tant parts of their
results ("Secondary outcomes were number and type of hypoglycaemic and
hyperglycaemic events, quality of life, compliance and satisfaction with
interventions, socioeconomic effects and HbA1c after 3 and 12 months.
Data on quality of life, satisfaction with intervention and on the
socioeconomic background will not be presented in this paper.").
> I wrote this comment on articles like this last month:
> http://loraldiabetes.blogspot.com/2008/07/how-often-should-we-test.html
> "How Often Should We Test?
> Over the past few years there have been some truly abysmal
> scientific research papers published on the futility of
> frequent self-testing by type 2 diabetics. Three that come
> to mind are The Fremantle Diabetes Study
> http://care.diabetesjournals.org/cgi/content/abstract/29/8/1764
> from Western Australia, Self-monitoring in Type 2 diabetes:
> a randomized trial of reimbursement policy
> http://www3.interscience.wiley.com/journal/118552827/abstract
> from Canada; and Impact of self monitoring of blood glucose
> in the management of patients with non-insulin treated
> diabetes: open parallel group randomised trial
> http://www.bmj.com/cgi/content/full/bmj.39247.447431.BEv1
> from the UK.
> All of these papers have three things in common: they were
> published in countries where the government subsidises test
> strip supplies to diabetics, and thus has an interest in
> cutting health budget costs; they considered testing more
> than once a day to be "frequent"; and they did not educate
> the subjects being studied on how to interpret test results
> with a view to adjusting their lifestyle to improve results.
> I previously discussed the UK paper by Farmer et al in
> Self-Testing and Type 2 Management a year ago. Those same
> comments apply to all those papers."
All this paper actually says is, if you're only going to be testing
a bit, sort of to do a background check every now and then (which is a
perfectly legitimate thing to do), then 4 times a week is no better than
once a week. They also say that the _actual_ number of tests done by
T2s not on insulin is 0.8 per week, so there's not much point trying to
get the "high" group to do more than 4 per week.
However, calling 4 tests per week "high" seems a bit off. All of these
doctors will have T1 patients whom they expect to do 4 or 8 tests a day.
> Cheers, Alan, T2, Australia.
--
Alan Mackenzie (Nuremberg, Germany).
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