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The article by Farmer et al reinforces our experiences in practice.1 We have not prescribed testing strips routinely to patients with stable type 2 diabetes for the past three years. Aggressive diabetic management based on principles of patient education, development of trust between trained diabetes nurses and the patient, and early use of oral agents to achieve target HbA1c levels have led to gratifyingly good outcome measures in our 3000 patient urban practice.
We discourage the use of self monitoring for several reasons: expense of testing strips and equipment, the anxiety generated by small variations in results and the subsequent medical time pressures in dealing with these, equipment failure, and the lack of evidence of any benefit. We have had pressure from hospital consultants, patients themselves, and pressure groups to provide testing strips, but we have firmly stuck to our guns. In the current state of knowledge, nothing would persuade us to go back to encouraging or supporting routine self monitoring in stable type 2 diabetes:our results are too good to justify the change.
Competing interests: None declared.