6.1.6 Diagnostic and monitoring devices for diabetes mellitus

Blood glucose monitoring

A patient information leaflet: Blood sugar (glucose) monitoring: Testing with a purpose is available and should be given to people with diabetes not using insulin to help them understand what to do with the results.

The current annual spend across the formulary area on test strips and reagents is approximately £1.5 million.

The DVLA guidance should be taken into account when considering the need for self-monitoring of blood glucose

Type 1 diabetes mellitus

Support adults with type 1 diabetes to test blood glucose at least 4 times a day, and up to 10 times a day if any of the following apply:

  • the desired target for blood glucose control, measured by HbA1c level, is not achieved
  • the frequency of hypoglycaemic episodes increases
  • there is a legal requirement to do so (such as before driving, in line with DVLA guidance on the medical standards of fitness to drive)
  • during periods of illness
  • before, during and after sport
  • when planning pregnancy, during pregnancy and while breastfeeding (see the NICE guideline on diabetes in pregnancy)
  • if there is a need to know blood glucose levels more than 4 times a day for other reasons (for example, impaired awareness of hypoglycaemia, high-risk activities).

Enable additional blood glucose testing (more than 10 times a day) for adults with type 1 diabetes if this is necessary because of the person's lifestyle (for example, driving for a long period of time, undertaking high‑risk activity or occupation, travel) or if the person has impaired awareness of hypoglycaemia.

For information on the use of the FreeStyle Libre device, including the local commissioning position, refer to section 6.1.7 FreeStyle Libre interstitial glucose monitor

Type 2 diabetes mellitus

The view that routine self-monitoring of blood glucose (SMBG) is unlikely to be beneficial in patients with type 2 diabetes who are not treated with insulin has been reinforced by two studies ESMON (2008) and DiGEM (2009). SMBG may even worsen quality of life and waste NHS resources.

NICE guidance recommends that SMBG should not be offered to people newly diagnosed with type 2 diabetes unless:

  • the person is on insulin or
  • there is evidence of hypoglycaemic episodes or
  • the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or
  • the person is pregnant, or is planning to become pregnant.

A structured review of self-monitoring in type 2 diabetics should be carried out at least annually.

Short term monitoring should be considered when starting treatment with oral or intravenous steroids or to confirm suspected hypoglycaemia.

Meter / Strips / Lancets

This list has been compiled with input from local diabetes specialists. Please take caution in deviating from this list under influence from industry sales representatives as the cost of alternate strips and lancets could be significantly higher. Those patients currently using meters that have been removed from the formulary should continue to use them until such time as they and their clinician think it appropriate to change. New formulary recommendations should be followed for all patients new to glucose monitoring in the following groups.

Meter Visual impairment Dexterity problems Cable free download
GlucoMen® Areo Yes Yes Yes
Accu-Chek® Performa Nano No Yes No
AgaMatrix® WaveSense JAZZ Yes No No
AgaMatrix® WaveSense JAZZ 'Wireless' No No Yes

All the following first line meters are suitable for use in type 1 and type 2 diabetes, and may be used in pregnancy and renal dialysis. For patients who are carbohydrate counting, or need to test for blood ketones, please see specialist meters below.

GlucoMen® Areo meter (Menarini)
GlucoMen® Areo Sensors test strips
  • £9.95 = 50 strips
  • Expiry of strips: 6 months after opening
  • Manufacturer contact number/patient care line: 0800 243 667
Glucoject® Lancets PLUS 0.2mm/33G
  • £5.50 = 200 lancets
Accu-Chek® Performa Nano meter (Roche)
Accu-Chek® Performa test strips
  • £9.95 = 50 strips
  • Expiry of strips: unaffected by opening – as per date on pack
  • Manufacturer contact number/patient care line: 0800 701 000
  • Meter may not be suitable for patients with visual impairment
Accu-Chek® FastClix Lancets 0.3mm/30G
  • £5.90 = 204 lancets
AgaMatrix® WaveSense JAZZ & WaveSense JAZZ 'Wireless' meters (AgaMatrix)
AgaMatrix® WaveSense JAZZ DUO test strips
  • £8.74 = 2 x 25 strips
  • Expiry of strips: 12 months (6 months after opening each pot)
  • Manufacturer contact number/patient care line: 0800 093 1812
  • Meters may not be suitable for patients with dexterity problems/limited dexterity
  • WaveSense JAZZ 'Wireless' meter may not be suitable for patients with visual impairment
AgaMatrix® Ultra-Thin Lancets 0.2mm/33G
  • £5.43 = 200 lancet

For patients who are carbohydrate counting or insulin pump users

These will be patients with Type 1 diabetes who have received structured education from the local Diabetes Specialist team may need to use specialist meters (as below) to assist them to calculate their insulin: food ratios.

Contour® NEXT meters (Ascensia)
Contour® NEXT test strips
  • £15.04 per 50 strips
  • Expiry of strips: 6 months after opening each pot
  • Manufacturer contact number/patient care line: 0845 600 6030
Accu-Chek® Aviva Expert bolus advisor meter (Roche)
Accu-Chek® Aviva test strips
  • £16.09 per 50 strips
  • Expiry of strips: unaffected by opening – as per date on pack
  • Manufacturer contact number/patient care line: 0800 701 000
  • Recommended lancets: Accu-Chek FastClix Lancets 0.3mm/30G (£5.90 = 204 lancets)
FreeStyle® InsuLinx meter (Abbott)
FreeStyle® Lite test strips
  • £16.10 per 50 strips
  • Expiry of strips: unaffected by opening – as per date on pack
  • Manufacturer contact number/patient care line: 0500 467 466
  • Recommended lancets: AgaMatrix® Ultra-Thin Lancets 0.2mm/33G (£5.43 = 200 lancets). NB these are not the lancets included in the meter pack

For patients who need to test for blood ketones:

With the advancements in technology of strips, testing blood ketones with capillary blood is much more accurate than testing urine for ketones. Type 1 patients who have unstable diabetes control and have a significant risk of developing ketones (after specialist advice) may benefit from testing their blood for ketones once their glucose level reaches an agreed upper limit and/or in times of acute illness. It is also recommended by NICE for all pregnant women with type 1 diabetes and advised for all those on insulin pump therapy.

GlucoMen® Areo 2K meter (Menarini)
GlucoMen® Areo Ketone Sensors test strips
  • £9.95 per 10 strips
  • Expiry of strips: unaffected by opening – as per date on pack
  • Manufacturer contact number/patient care line: 0800 243 667
  • Recommended lancets: AgaMatrix® Ultra-Thin Lancets 0.2mm/33G (£5.43 = 200 lancets). NB these are not the lancets included in the meter pack
FreeStyle® Optium Neo meter (Abbott)
FreeStyle® Optium β-ketone test strips
  • £21.53 per 10 strips
  • Expiry of strips: unaffected by opening – as per date on pack
  • Manufacturer contact number/patient care line: 0500 467 466
  • Recommended lancets: AgaMatrix® Ultra-Thin Lancets 0.2mm/33G (£5.43 = 200 lancets). NB these are not the lancets included in the meter pack

 

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