For those interested in seeing a review of three new glucose meters on the market, I recommend reading this blog post from Adam Brown(diaTribe). He reviews the OneTouch VerioIQ, Telcare, and Freestyle InsuLinx meters. Each of these new meters has different feature sets that try to differentiate it by doing more than “just checking a glucose level.”
I don’t have diabetes. But I do think about diabetes a lot, read about diabetes a lot, and certainly talk about diabetes a lot. So, this past week, I decided it was time to walk the walk. I opened up a shiny package for a new glucometer with the plan of monitoring my glucose 3 or 4 times a day for several days. I actually read the instruction manual on how to properly set the time and date, and did so within a few minutes. As long as I was going to do this, I at least wanted my data to be accurate, a true “quantified-self” experiment (of course, choosing a night where I went out for a hamburger and fries was a true test of my pancreas’ abilities!).
Then, like a know-it-all physician, I tried to check my sugar. “Er5” said the screen. Hmmm. Did it again. Punched hole #2 in my finger. Ouch. “Er5.” Maybe I didn’t get a big enough drop of blood. So, I cranked up the dial on the lancet device from “3” to “9” so I could get the deepest finger puncture and guarantee a burgundy nugget for the test strip. This time, “ouch” out loud. “Er5” on the screen again. I did this several times, howling in pain down the hall of my apartment, and said to my fiancee, “this hurts! I can’t believe I ask people to check their sugar multiple times a day! And worse, I can’t even do it right!” At this point, I figured the test strips must be defective so I googled “Er5 onetouch ultramini” to see what was going wrong.
I didn’t have another vial of test strips so I was hopeful that “test strip damage” was not my issue. If it was, my experiment would be over rather quickly. I had to read a little further to find out that an “incompletely filled confirmation window” actually means, “you are not putting the blood on the test strip properly.” It turns out, rather than placing the drop of blood to the side of the test strip for it to be sucked in to a small channel, I had been just plopping the blood on top of the strip. Whoops! Embarrassing!
After discarding nearly a dozen wasted test strips into the garbage, I finally struck gold and got a real, live number on the screen. “86” it read, and though my finger stung, I had finally erased the humiliating sting of “Er5.” For the next 24 hours, I checked my fingerstick on schedule, but noticed that it REALLY hurt and that I had to talk myself into pressing that button on the lancet each time, knowing the pain that would follow. I commented about this to one of our diabetes educators, Catherine, who laughed and spent ten minutes showing me the proper way to use a lancet to get a blood sample, ie using the side of my finger instead of the tip and shaking my hand toward the floor to get blood flowing into it. Turns out, if you do it the right way, you can get a drop of blood with a lot more ease and a lot less pain. Though I consider myself pretty good at helping analyze blood sugar patterns, I finally now, after four years of medical school, three years of Internal Medicine residency, a year as Internal Medicine faculty, and nearly a year of Endocrinology fellowship, actually know the right way to check a blood sugar.
Luckily for me, this experience was only that, and is not something I have to endure on a daily basis. But as I spend my career trying to improve diabetes technology and caring for those of you with diabetes, you can at least know, that I do understand your pain. And if a patient one day asks me why her meter says “Er5,” I hope she will forgive me if I take a moment to laugh at the dozen half-filled-with-blood test strips in my garbage can.
Still not available in US (though finally FDA approved), but now available in the UK, is the iBGStar from Sanofi. This device is similar in spirit to the Glooko iPhone connector dongle that I recently wrote about here.
This is a very exciting device because it will allow patients to electronically capture their blood sugars without any extra work. No more transcribing numbers into a logbook, either a paper one or even a digital logbook. As soon as you check your blood sugar, the number is already captured into a digital logbook with no extra work. This device clearly has an advantage over the Glooko solution in that the data is collected in real-time, rather than needing a connection and download the way the Glooko does. The introduction of real-time data upload brings the possibility of shorter and faster feedback loops between patient and clinician. There is also no extra hardware to potentially lose, since the extra hardware is your glucometer. Glooko’s advantage is that it works with many existing glucose meters, so you can get the one covered by your insurance, and still easily digitize the data. So, they each bring a unique new capability to glucose monitoring that should be welcome.
New study published by Harry Fischer and colleagues in Denver shows increased participation in care by diabetes patients who received text message reminders between visits. It looks like there was a big increase in the number of patients who provided glucose readings among the group receiving text messages. Most importantly, the patients reported that they felt “more accountable.” Accountability and patient empowerment are the trends that will continue to be more and more important and essential.
Objectives: To assess the feasibility of engaging adults with diabetes in self management behaviors between clinic visits by using cell phone text messaging to provide blood sugar measurement prompts and appointment reminders.
Study Design: Quasi-experimental pilot among adult diabetic patients with cell phones who receive regular care at a federally qualified community health center in Denver, Colorado, which serves a population that is predominantly either uninsured (41%) or on Medicaid or Medicare (56%).
Methods: Patients (N = 47) received text message prompts over a 3-month period. Blood sugar readings were requested 3 times per week (Monday, Wednesday, and Friday). Reminders were sent 7, 3, and 1 day(s) before each scheduled appointment. Acknowledgments were returned for all patient-sent messages. Focus groups were conducted in English and Spanish with selected patients (n = 8).
Results: Patients of all ages were active participants. Correctly formatted responses were received for 67.3% of 1585 prompts. More than three-fourths (79%) of the cohort responded to more than 50% of their prompts. The appointment analysis was underpowered to detect significant changes in attendance. Participants reported increased social support, feelings that the program “made them accountable,” and increased awareness of health information. Two-thirds (66%) of patients provided glucose readings when prompted during the study, compared with 12% at 2 preceding clinic visits.
Conclusions: For certain patients, cell phone–based text messaging may enhance chronic disease management support and patient-provider communications beyond the clinic setting.
(Am J Manag Care. 2012;18(2):e42-e47)
The United Kingdom’s National Health Service, according to this Telegraph article, plans to start recommending that physicians start prescribing certain mobile health apps to their patients. Examples include electronic reminders to check blood sugar or take a medication. Though I’m not sure that the examples provided present the strongest use cases possible for mobile health apps, I think they’re certainly on the right track. An app that increases the probability that someone remembers to take their medications regularly should accomplish improved healthcare outcomes and improved value.
We have to find ways of building mobile applications that patients find engaging, that they are willing to use, and that will empower them to take charge of their health. Apps that do these things should save the system money and improve healthcare outcomes. The NHS clearly thinks that some of these apps are ready to start serving those functions. It will be a nice experiment to see if they’re right.