GUIDELINES FOR CHOICE OF BLOOD GLUCOSE TESTING STRIPS, LANCETS AND METERS
These Guidelines are intended to assist healthcare professionals in the selection of appropriate blood glucose meters and testing strips for patients to self-monitor their
blood glucose levels. These Guidelines should be used in conjunction with Mid Essex Self Blood Glucose Monitoring (SBGM) Guidelines.
The recommendations on choice of meter in this guideline reflect a multi-disciplinary review of several requirements including:

Compliance with the new ISO standards (01.05.2016) for glucose testing meters

Cost and expiry of test strips

Clinical features of meters for example connectivity, suitability for particular patient groups, support for patient self-management, any known interference with
prescribed medicines

Compatibility with DVLA requirements
The need for a meter for newly diagnosed diabetics will be assessed by a healthcare professional and if required a suitable meter will be supplied to the patient. These
meters will be provided free of charge from GP surgeries or diabetic clinics. There should be no need for a patient to purchase a meter and patients should be
dissuaded from doing so without consulting their specialist first. Prescribing of strips and lancets for patients who purchase a meter is not supported by the CCG.
This guideline has divided meters into 2 broad categories.
1. The majority of patients with diabetes (including those using insulin) should be offered a meter from category 1, these are cost-effective and the table of key
features (pg3) enables informed decision making between clinician and patient. Practices should routinely stock these meters (available free of charge from
the manufacturer) and offer them to patients who meet the criteria for self-management of blood glucose
While the CCG would not challenge the prescribing of alternative test strips, priced at less than £10 / 50 strips;
healthcare professionals who recommend or prescribe these to patients are accepting responsibility for ensuring
compliance of these meters with ISO and DVLA requirements
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Who should be testing?
 All patients with Type 1
diabetes
 All pregnant women with
pre-existing or
gestational diabetes
 All patients with Type 2
diabetes using insulin
 Non-insulin managed
patients with T2DM who:
o Are prescribed
sulfonylureas or
glinides
o and who also drive
(see right)
o Have been newly
initiated or dose
titrated with GLP
analogue (e.g.
exenatide) for short
term only (<3
months)
Who Should Not Need to
Test?
 Those with Type 2 DM
controlled by diet and
exercise alone
 Patients with Type 2
diabetes controlled by
metformin alone or in
combination with
pioglitazone or a gliptin
2. Category 2 meters are reserved for specific groups of patients with T1DM, they are usually initiated in secondary care or
tier 2 diabetes services and strips continued in primary care. It is not anticipated that category 2 test strips would
account for more than 20% of primary care test strip prescribing. Category 2 meters do not need to be routinely stocked
in primary care but may be ordered ad hoc from manufacturers if patient meets criteria for use.
Criteria for category 2 meters:
 Carbohydrate counting insulin users who have undergone BERTIE course or similar or
 T1DM with brittle control (frequent DKA)
 Those using a sub-cutaneous insulin pump
Patients prescribed these products who meet this criteria should not be changed by healthcare professionals in primary
care, as they have been specifically selected for complex patients
Patients, who purchase a meter where an off-formulary strip is used, should expect to purchase the strips as well. Community
pharmacists should not sell blood glucose meters to patients with diabetes without prior discussion and approval from the
patient’s diabetes healthcare professional. Practices should dispose of, or not accept, free samples of non-formulary meters from
drug companies. All of the meters included in this guideline are available at no cost to the patient.
Glucose testing for drivers?1
Treated with Insulin
 Group 2 Drivers (lorries/buses):
o Should monitor blood glucose at least twice daily and at times relevant to driving (no more than 2 hours before
the start of the first journey and every 2 hours while driving).
o Must use a meter with a memory function with no delete facility which records blood glucose levels, as they will
be required to have three months of blood glucose readings available for inspection at an annual examination by a
consultant diabetologist.
 Group 1 Drivers (cars/motorcycles):
o Should monitor blood glucose at least twice daily and at times relevant to driving (no more than 2 hours before
the start of the first journey and every 2 hours while driving).
Treated with tablets which carry a risk of hypoglycaemia (Sulfonylureas and Glinides)
 Group 2 Drivers (lorries/buses):
o Should monitor blood glucose at least twice daily and at times relevant to driving
 Group 1 Drivers (cars/motorcycles):
o The frequency of testing depends upon the clinical context, it may be appropriate to monitor blood glucose
regularly and at times relevant to driving to enable the detection of hypoglycaemia.
o The greatest risk of hypoglycaemia with sulphonylureas is in the first three months of treatment therefore people
who are just starting treatment, experiencing hypoglycaemia, or have reduced awareness are likely to need to test
more frequently.
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Category 1: Meters suitable for majority of people with T2DM (including those using insulin), and some people with T1DM
Glucomen Areo
Contour TS
Supercheck 2
One Touch Select Plus
Product photo
Memory
Smart phone upload
Compatible test strips
50 strips (£)
Expiry after opening
Lancets
Preferred meter () ,
alternative choice () or
not suitable ()
Contra-indications
250 tests
Yes
Glucomen Areo
No
Contour TS
500 tests
No
Supercheck 2
£9.99
£9.95
£9.50
£8.49
Note: no interference with
medication/drugs in normal ranges
Note: no interference with
medication/drugs in normal ranges

Interference with results accuracy
in patients taking levodopa
Note: no interference with
medication/drugs in normal ranges



DM in
pregnancy
Partially
sighted

 (unless Group 2 driver)





 (unless Group 2 driver)



 (unless Group 2 driver)




Contact to order FREE
meters
Patient helpline details
730 tests
18 months
6 months
24 months
6 months
Use the most cost effective lancets (<£3/100), these are not necessarily the ones supplied with the meter. Refer to Cost effective lancet table on page 7
T2DM (noninsulin
treated)
T2DM using
insulin
T1DM
Additional
considerations on
choice of meter
500 tests
No
One Touch
Good for tracking patterns,
averages
Colour range indicator for low,
high or in range
Target ranges can be
individualised


Patients wishing to use with
Smart phone
Drivers, (especially Group 2)
using insulin who require large
test memory for DVLA


Type 2 diabetes who require
occasional / infrequent testing
Simple to use, especially for
manual dexterity issues (when
smaller, modern meters may
pose handing problems)




Speaking results function
RNIB approved
Simple to use meter
Not compatible with Gp2 DVLA
requirements (can erase results)
Sam Frazer: 07976138629
Jitesh: 07885 555676
[email protected]
Helen:
[email protected]
Tel: 01636 831201
Mon – Fri 8.30am – 6pm and Saturday
9am – 1pm: 0800 121 200
Mon to Fri 8:30am - 5:30pm
 0800 243 667 / 0118 9444128
Bayer/ Ascensia Diabetes Support
 0845 600 6030
Tel: 01636 831201
[email protected]
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Category 2: Meters suitable for people with T1DM who have undertaken BERTIE course and other specific groups of patients
(for example: carbohydrate counting, insulin pump users, paeds or brittle glycaemic control)
Name of Meter
Accu-Chek Aviva Expert
Contour Next
Accu-Chek Performa Nano
Accu-Chek Mobile
1000 tests
Accu-Chek Aviva
800 tests
Contour NEXT strips
500 tests
Accu-Chek Performa
500 tests
Accu-Chek Mobile test cassette
Product photo
Memory
Compatible test
strips
50 strips (£)
Expiry after
opening
Lancets
Contra-indications
Preferred meter
for
Additional
considerations on
choice of meter
Contact to order
FREE meters
Patient helpline
details
£15.72
£15.04
£9.95
£16.09
18 months
24 months
18 months
3 months
Use the most cost effective lancets (<£3/100), these are not necessarily the
ones supplied with the meter. Refer to Cost effective lancet table on page 7
Test results affected by drugs that
contain or metabolise to maltose:
peritoneal dialysis fluids,
immunoglobulins, abatacept
Note: no known interference with
medication/drugs in normal ranges
Carb counting T1DM

Calculates the units of insulin
required based on test result,
expected carb intake and
previous insulin doses
Brittle glycaemic control or
Low haematocrit levels


Fastclix Lancet drums (£9.75/204) reserved for T1DM patients with needle
phobia, mobility problems or visual impairment. Otherwise refer to cost
effective lancet table on page 7
Test results affected by drugs that
Note: no known interference with
contain or metabolise to maltose:
medication/drugs in normal ranges
peritoneal dialysis fluids,
immunoglobulins, abatacept
Paediatric patients with T1DM
Restricted – see below

Can accurately test even when
haematocrit levels are low
Helpful for those with brittle
control

Reserved for T1DM patients with
mobility problems or who are
visually impaired
Prescribing of cassettes to
patients in primary care who do
not meet criteria is not supported
Sajad Rahman : 07912 163529
Helen:
[email protected]
Sajad Rahman : 07912 163529
Sajad Rahman : 07912 163529
Mon to Fri 8am - 6pm (excluding
bank holidays): 0800 701 000
Bayer Diabetes Support
0845 600 6030
Mon to Fri 8am - 6pm (excluding
bank holidays): 0800 701 000
Mon to Fri 8am - 6pm (excluding
bank holidays): 0800 701 000
Some patients self-fund the Free Style Libre meter which comes with a sensor the patients insert into their arm for 14 days and can scan for blood glucose. These are not currently considered cost
effective and in the absence of a positive decision from the National Institute of Health and Clinical Excellence, MECCG do NOT support prescribing of the sensors. However patients require compatible
blood glucose test strips for the meter if hypo or for DVLA. This is appropriate in Type 1 patients who are self-funding the sensor device since the price of the additional strips would not be expected to
exceed monitoring costs for other people with type 1 diabetes. Compatible strips are Freestyle Optium Neo (£15.64 / 50 strips).
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Prescribing of Blood Ketone Testing Strips in patients with Type 1 diabetes
Ketone testing is occasionally required for some patients (e.g. those using insulin subcutaneous pumps, pregnant T1DM, those who are carbohydrate counting or brittle
glycaemic control). Patients required to self-test for ketones will be identified by the diabetes specialist service and provided with the initial supply by the specialist
service. It may be necessary for primary care to repeat prescribe such strips. The use must be carefully monitored and it is not expected that this will exceed more than
one pack per year, with the exception of insulin pump patients.
The local diabetes team do not support the use of combined meters for both glucose and ketone testing (where patients may measure both on the same device by using
different strips) due to safety concerns of inadvertent mix up of the strips or results. These meters should only be used for ketone testing, an alternative glucose meter
should be selected from the appropriate category above.
Meter
Company
Ketone test strip
Price
Freestyle Optium
Abbott
Optium β Ketone
£20.63 x 10
Expiry once
open
18 months
(individually
foil wrapped)
Glucomen LX plus
Menarini
Glucomen LX
Ketone
£20.75 x 10
9 months
Recommended?
Yes – on
specialist
recommendation
only
No (due to
expiry)
Quality Standards
There are no reliable national or international datasets comparing the quality and accuracy of different BG machines. The field of Health Technology Assessment (HTA)
is several years behind the quality standards achieved in medicines licensing. The new range of BG machines have device components frequently developed and /or
utilised in the Far East, and then repacked and authorised for European Union markets. It is important that healthcare professionals should be aware that variability of
device accuracy and durability can occur with any of the above medical devices, and that if a patient reports problems it is perfectly appropriate to re-issue a new or
replacement device from the same class.
Educational Support
The cornerstone of good glycaemic care is the quality of the support and educational relationship between the healthcare professional and the patient, and not the BG
machine per se. A patient who doesn’t understand why and when BG testing should be done, will either inappropriately over-test or fail to test when needed. We would
strongly encourage a patient-centred approach to explaining to all patients the rationale for BG checks for different situations, at the point when BG machines are first
issued and when BG results are periodically inspected.
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Switching blood glucose meters:
The meters and strips recommended in this guideline have been reviewed as meeting all the minimum standards for safety, quality control, memory and costeffectiveness.
Mid Essex CCG currently spend more than £1m per year on blood glucose testing strips. 61% blood glucose test strips prescribed in MECCG cost over £15/50 strips
despite their being many available and suitable meters on the market with strips costing less than £10 for the same quantity. The category 1 meters in this guideline are
examples of some of these that meet the ISO required accuracy standards and many have new features and usability, enabling a wider patient choice in this price
bracket.
It is recommended that all patients with Type 2 diabetes currently prescribed strips costing more than £10 per 50 test strips are reviewed and that the category 1
table is used, in consultation with the patient, to select a suitable alternative. Remember that if a meter is to be switched for the purpose of cost saving, any existing
supply of strips the patient has for the old meter should be used up first.
It is not expected that patients already on a meter with strips costing less than £10 / 50 strips would be changed, provided the meter is complaint with ISO requirements
(to be met by May 2016). Meters that do not meet these requirements have largely been removed from the market and are only likely to present as an issue in patient
who test infrequently. Should a patient present with a discontinued meter / test strips, review the need for glucose testing and if required, use the category 1 table
above to select a suitable alternative.
While the CCG would not challenge the prescribing of alternative test strips, priced at less than £10 / 50 strips; healthcare professionals who recommend or prescribe these to
patients are accepting responsibility for ensuring compliance of these meters with ISO and DVLA requirements
1
‘At a glance guide to the current medical standards of fitness to drive’: May 2014. Available at:
http://www.dft.gov.uk/dvla/medical/ataglance.aspx [Accessed 28.8.14]
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Lancets:
o
Use cost-effective lancets (which may not be the ones provided with the meter). There are a range of different sized lancets available on prescription at a cost
of ≤£3 / 100 and these are listed in the table below.
o
The higher the gauge (G) of a lancet; the smaller the diameter of the needle. A low gauge needle (28G) may be quite uncomfortable for the patient while a higher
gauge (33G) may not provide sufficient blood for testing. Generally 30G lancets are suitable for most patients
o
Lancets are designed to fit into proprietary finger-pricking devices but from local experience most appear to be a universal fit for all. Finger pricking devices are
not prescribable but are supplied with the blood glucose monitoring meter.
o
Lancets are for single use only, ensure patients are educated about safe disposal via sharps bin
o
Multi-device lancets (Multiclix Roche or Fastclix drum), which contain a preloaded lancet drum, should be restricted to those with clinical need e.g. those
with dexterity problems, needle phoebia or visual impairment
Medium gauge 30G lancets - suitable for most patients
(0.28 – 0.38 mm) with low acquisition cost (≤£3.00/100)
Lancet
Diameter / Gauge
Packsize
Cost / pack
Carasens
0.31mm/30g
100
£2.95
Safety lancets – Do NOT prescribe on FP10
GlucoRX
0.31mm/30g
200
£5.50
o
Unistik 3 are safety lancets, the needle retracts after use.
ICare Advanced
0.38mm/30g
100
£2.85
o
ICare Advanced
0.38mm/30g
200
£4.45
IME-DC
0.3mm/30g
100
£3.00
Microdot
0.31mm/30g
100
£3.00
Microdot
0.31mm/30g
200
£6.00
Mylife (multicoloured )
0.3mm/30g
200
£5.50
Mylife (standard)
0.3mm/30g
200
£5.50
These are primarily for the benefit of
healthcare workers to avoid needle stick
injury, not for the benefit of the patient
They should not be prescribed by GPs on
FP10s.
They may be ordered as a stock item by
healthcare providers who require them to ensure the safety of
their staff
Omnicon Lance Soft
0.3mm/30g
200
£5.45
TRUEplus
0.32mm/30g
100
£2.90
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Title
Document reference
Author
Approved by
Date approved
Review date
Glucose Testing Strips and Meters
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Catherine Hamilton, Deputy Chief Pharmacist, MECCG
Mid Essex Medicines Management Committee
February 2016
February 2018
Previous version
Guidelines for choice of blood glucose testing
strips and meters - August 2014
Cost effective lancets for patient use - June
2014
Key changes
Combined glucose testing strips, meters and lancets into one guidance
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