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In my office, there is a box. Nothing fancy, just a plain brown box filled with a collection of "old school" diabetes stuff: "boil and re-use" syringes, urine test tape, screw-driven insulin pumps, medieval injection aids and lancing devices, and so on. Of course, no such collection would be complete without an array of classic blood glucose meters. The oldest one I have is a plug-in-the-wall model called a "Dextrometer" that featured test strip rinsing solution and a red LED display that could burn the retina of anyone within six feet.
Of course, my first meter (circa 1985) was much more high-tech (all 12 ounces of it). Shaped like a brick, powered by a 9-volt battery, slower than the FDA, and eerily creaky, it sucked up huge drops of blood like a thirsty vampire. It wasn't pretty, but hey, it got the job done. And it sure beat the heck out of trying to compare a bloody "chemstrip" to eighteen different shades of blue on the side of a vial. Now, whenever patients come to my office and complain about having to check their blood sugar, I whip out "old trusty" and try to teach them a thing or two about perspective.
Over the past 25 years, blood glucose meters have evolved rapidly. Today's meters are much smaller, faster, more accurate, and easier to use, and they require a mere fraction of the blood needed by earlier models. They are also a bit more stylish than they used to be. Just about every meter comes in a variety of colors. If colors are not an option, there are adhesive stickers that can give your meter just the look you desire.
So where do we go from here? Are we still making quantum leaps, or has meter evolution come to a grinding halt?
Having attended most of the major diabetes conventions over the past couple of years and seen all of the "latest and greatest" that the medical device industry has to offer, all I can say is, "Is that the best you can do?" The recent improvements in blood glucose meters are so minor (dare I say "insignificant"?) that you might not even notice any change. For example, here's what the "big four" meter manufacturers had to show off at this year's meetings:
Bayer's big news involves the release of their new Contour USB meter. It uses the same test strips as their previous Contour meters, but this one has a bright full-color screen and a built-in USB connector. And it's only slightly larger than a computer memory stick. The test strip port also lights up in case you find yourself testing your blood in total darkness (can't remember the last time I needed to do that). The major advantage of this meter is its "plug and play" technology: The downloading software for reviewing/analyzing the meter data is stored in the meter itself. When you plug the meter into a PC or MAC USB port, the program pops up and you can view your reports right on the computer screen. Of course, the older Contour meters can be downloaded too, but you have to first download Bayer's Glucofacts software to your computer and then plug the meter in.
Another recent innovation from Bayer is the Didget blood glucose monitor. Designed mainly for school-age kids, it uses the same Contour test strips as other Bayer meters, but it also plugs into a Nintendo DS handheld game system. Points are awarded for testing blood sugar, with reward points issued for achieving target levels of glycemic control. The points can be redeemed to play certain games and unlock new game levels. Not a bad idea, if you're a school-age kid, have a Nintendo DS, and like the specific games that Didget offers. It's even better if your non-diabetic brother or sister is willing to let you use his/her blood to rack up points.
Games aside, Bayer meters (particularly the Contour meters) remain a popular choice for those who want a relatively simple system without too many bells and whistles. Bayer was first with code-free testing, and their large test strip vials are a hit with the elderly. Perhaps the new Contour USB meter will make a splash with those who like the "plug and play" concept for analyzing blood sugar data. Or maybe not.
Lifescan's big news involves a redesigned test strip for the OneTouch Ultra meters. The new strip, which is blue rather than white (oh boy!), is manufactured under more controlled conditions, so the code number from one vial to the next does not change. It's always 25, so after you set the code number once, you can leave it there. The strip also has something called "Double Sure Technology," which means that the glucose level is measured via two separate terminals in the strip. If the readings from the two terminals match up, the result is displayed. If they don't match up, the sample is rejected and you'll need to repeat the test. Which begs the question, shouldn't these things be accurate without having to check twice? Anyway, the meters themselves haven't changed... just the strips.
Oh, one more thing. Lifescan has a new lancing device called the "Delica." (I just love the names they give these things. I guess nobody would want to use a lancing pen called the "Bludger.") Delica has a "stabilizing" process that minimizes the amount of vibration during the lancing process. Supposedly, this makes fingersticks more comfortable. You be the judge.
OneTouch Ultra meters are a logical choice for those who use insulin pumps that are linked (via radio signals) to the meters. Using OneTouch Ultralink, which communicates with Medtronic Paradigm insulin pumps, and OneTouch Ping, which links with the Animas Ping pump, simplifies the data entry and mealtime bolus calculation process. And the UltraMini meter, with its slim/simple design, is an excellent choice for testing on-the-go.
Abbott's latest innovation really had me clamoring for more. Their FreeStyle and FreeStyle Lite test strips have always required the smallest blood sample in the industry and were extremely easy to dose. Now, they've added little pointy things to the sides of the strips to help draw the blood into the strip even more easily. They call it "Zip-Wik" technology. (Just try saying that without smiling. I dare you.) Initially, these new Zip-Wik strips (See? You're smiling!) will only be available for FreeStyle Lite systems. Those using traditional FreeStyle meters, including users of the meter built into the OmniPod PDM, Cozmonitor attachment for the Cozmo pump, and Navigator CGM, will unfortunately be Zip-Wikless for the time being. I only pray that a coping hotline will be made available.
FreeStyle and FreeStyle Lite meters made their mark because of the tiny 0.3 microliter blood sample required to perform a test. This opened the door to "alternate site" testing and continues to set the standard in dose volume. FreeStyle meters are also very compact and portable. These features make them logical choices for children, teens, and adults who test frequently. The FreeStyle meter is also the "choice of force" for users of the OmniPod pump, Deltec Cozmo pump, and Navigator continuous glucose monitor.
Roche, thankfully, had nothing new to show... just their usual arsenal of meters (including the "made in America" Aviva and the "all-in-one" Compact) and the Soft-Clix lancing device with the amazing rotating head for those who change their lancet more than once a month. No kung-fu grip rubber meter attachments. No unique odor emissions for the visually impaired. And not a single attempt to spice up the test strip vials with Disney characters or NFL team logos. I'd say I was disappointed, but after all the other "major advances" I saw, that would be impossible.
AccuChek meters are among the oldest and most trusted in the industry. They link with the Palm device that comes with the AccuChek Spirit insulin pump. The Compact and Compact Plus meters, with their built-in lancing device and 17-test strip rotating drum, are the only truly all-in-one meters on the market. This makes them good choices for frequent travelers, athletes, and anyone who needs to test on-the-go and doesn't want to carry multiple items.
So Where's The Innovation?
To be honest, the real innovation in blood glucose monitoring is coming from some of the smaller, lesser-known companies.
Prodigy Diabetes Care was recently honored by the National Federation for the Blind for their Prodigy Voice and Prodigy AutoCode meters. These are the first truly user-friendly blood glucose meters for people with severe visual impairment - complete with fully audible communication and tactile features. For those with moderately limited vision, the Prodigy Pocket meter features a large display and built-in magnifier. Obviously, this is a company that understands the needs of its niche market and focuses on meeting those needs.
Sanvita, makers of the Nova Max meter (formerly BD Logic), has introduced Nova Max Plus. This new meter has the ability to measure not only blood glucose, but also blood ketone levels using separate test strips. Unlike Abbott's Precision XTra meter (which also measures blood glucose or blood ketone levels), no special coding is required for either type of strip. The blood sample size with the Nova Max Plus meter is also much smaller. Any meter can measure blood sugar, but timely, accurate ketone measurements are essential for pump users (to troubleshoot pump-related problems), pregnant women, and during sick days. This meter measures both with relative ease.
Finally, say what you will about Walmart's smiting of small-town America, the fact is that they know how to save Joe Consumer a buck or two. For those who lack adequate health insurance, Walmart's ReliOn meters and strips are the best deal this side of the Mississipi. ReliOn's Confirm and Micro meters cost just $12. And more importantly, the test strips for these meters are priced at $20 for a vial of 50. For those doing the math at home, that's just 40 cents per strip - about half the price of most other companies' strips. Sure, the meters are fairly basic, but when you stand to save megabucks on the strips, who really cares?
So there you have it: the state of blood glucose monitoring, 2010. Nothing terribly exciting, and not much different from 2009, or 2008 for that matter. All things considered, I'm thinking about going back to that trusty 12-ounce brick of a meter I had back in the ‘80s.
Anybody know where I can get a 9-volt battery?
Editor's note: Gary Scheiner is a certified diabetes educator with a private practice (Integrated Diabetes Services) located near Philadelphia. He and his team of CDEs (all of whom have diabetes) offer consultations via phone and Internet worldwide, with a focus on intensive insulin therapy and advanced self-management training. Gary is the author of four books on diabetes self-care, including Think Like A Pancreas: A Practical Guide to Managing Diabetes With Insulin. He has had type 1 diabetes for 25 years and counting. For more information about his services, call (877) 735-3648, visit www.integrateddiabetes.com, or email email@example.com.
0 comments - Sep 9, 2010