At-Home Testing Essential for All Diabetes Patients

By Sipkoff, Martin | Drug Topics, October 2002 | Go to article overview

At-Home Testing Essential for All Diabetes Patients


Sipkoff, Martin, Drug Topics


Writer Miriam Tucker has had Type 1 diabetes for 30 years. She said use of a home testing device to measure her blood sugar is "absolutely essential. I couldn't survive without it."

Although most diabetes patients don't require the four meter readings and insulin injections a day that keep her alive, Tucker regrets that more patients don't carefully monitor their blood sugar at home. "Even people with Type 2, who are on pills instead of insulin, can benefit from knowing their daily blood sugar level, keeping a record, and reporting that information to their doctors," she said. Diabetes experts agree with Tucker: Home testing devices can keep virtually all diabetes patients healthier and more of them should be using these devices. The complications of diabetes could be dramatically reduced if patients maintained adequate control of their disorder, adjusting their diet and exercise routine to the results of home monitoring, according to the American Diabetes Association. ADA and other professional organizations say pharmacists should play a greater role in encouraging the appropriate use of these devices.

Many diabetes patients need encouragement. Home testing can be a daunting process, especially at first, although manufacturers of the approximately two dozen meters on the market are trying to make the procedure simpler and less painful. About one in 10 diabetes patients have Type 1 diabetes, what used to be called "juvenile diabetes" because it usually begins at a young age. For them, testing requires pricking a finger, arm, or thigh with a lancet as often as four times a day, placing a blood drop on a special testing strip, inserting the strip in a meter, waiting for the results, recording the results (although most meters maintain that information), and sometimes adjusting an insulin dose based on the readings. The higher the blood glucose, the more insulin required-a calculation process some patients find difficult.

Patients with Type 2 diabetes follow the same procedure but less frequently Patients taking pills instead of insulin shots-the case with the majority of Type 2 patients-don't adjust their dosage but can report the data they collect to their physicians for possible prescription adjustment. As troublesome and painful as it may be, the effort is worth it, according to ADA and others. "It is painful," said Tucker, "but you get used to it."

The effect of increased home testing on healthcare costs is also significant because there are a lot of diabetes patients, although estimates vary as to how many. ADA believes about 17 million Americans have diabetes, but five million of them don't know it.

Regardless of how many people suffer from the condition, the number of diabetes patients who practice self-- monitoring of blood glucose (SMBG) is comparatively small. Only about 2.5 million patients use one the available home testing devices, according to William Alto, M.D., associate professor of community and family medicine and diabetes specialist in the Maine-Dartmouth Family Practice Residency program in Augusta, Maine. That means that as many as 85% of the nation's diagnosed diabetes patients do not use home monitoring devices to monitor their blood sugar, according to ADA.

ADA officials call that number dangerous and unfortunate. "SMBG is recommended for all insulintreated patients with diabetes, and it may be desirable in patients treated with sulfonylureas or other insulin secretagogues and in all patients not achieving glycemic goals," states ADA's position paper on home testing.

ADA experts acknowledge that home testing isn't perfect. An ADA panel concluded several years ago that up to 50% of SMBG determinations might vary by more than 20% from a true value. But ADA experts believe that in monitoring blood sugar, imperfect information is better than none. "The knowledge is available to prevent a lot of suffering," said Richard Kern, PhD., the ADA's chief scientific and medical officer. …

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