A
REVIEW
OF
THE STATE OF THE ART
TECHNOLOGY
FOR THE DIABETES MANAGEMENT
Preamble
The
twentieth century had witnessed two epoch
making events in the management of diabetes
mellitus:
v
The
discovery of INSULIN
in 1922;
and ,
v
The
development of self-monitoring of blood
glucose levels in 1978.
As
the new millenium dawns, important advances
are further being made in the field of
glucose monitoring technology that
enables better diabetes management.
Self–monitoring
Systems
Self–monitoring
of blood sugar allows diabetics to measure
their blood glucose levels at home, adjust
treatment regimens as needed, and achieve
near-normal blood glucose levels.
Frequency
Of Monitoring
The
frequency of monitoring depends on the patient’s
current glycemic control and the type of
diabetes. In case of:
Type
1 Diabetes
patients should test four or more
times a day to obtain information needed
to maintain near-normal levels of blood
glucose.
Type
2 Diabetes
patients, who are not on insulin and their
glycosylated hemoglobin (HbA1c) values are
less than 7% may not require very intensive
monitoring.
If HbA1c is higher than 7 %, monitoring
of
preprandial (fasting) and postprandial
(post-meal) blood glucose levels is necessary
to determine the best treatment regimen.
Regardless
of the therapy,
frequent
monitoring is one of
the
keys to optimal glucose control.
The
New
Monitoring
Meters
The
new technology has moved from photometric
to electro-chemical glucose sensing, and
the new meters are smaller in size and require
less blood
for testing than their earlier versions.
With the help of these new devices,
glucose readings can be obtained in as little
as 5 seconds. Further, alternative-site
testing (arm/leg) instead of just fingerstick
testing, has recently been approved
for four meters, namely: At Last-Amira Medical,
Fast Take–Life Scan, Inc., Free Style–Thera
Sense Inc., One Touch Ultra– Life Scan Inc.
Decision
Criteria
All
meters are reliable under test conditions
and in clinical settings if the reagent
strips and electrodes are fresh and protected
from environmental factors such as heat,
light and moisture.
Differentiating factors are:
¨
The
amount of blood required for testing:
0.3 to 10 microliters
¨
Testing
Time:
5 to 45 seconds
¨
Size
of the meter: Quite a wide range as it is
in the case of cellular phones these days.
¨
Presentation
of the memory data: Limited built-in memory
to the facility of downloading to computer.
¨
Drawing
of blood for testing: Finger tip only to
alternative site testing
¨
The
Price:
Varies according to their versatility.
The
decision would therefore depend on the features
one requires, on the one hand,
and the price one can afford, on
the other.
The
best
that
a diabetes patient
can
do is to take the advise
of
his/her informed healthcare provider
Diabetes
Laser
Blood Test
The
Food and Drug Administration
(FDA), USA has recently approved
Lasette, a battery operated laser ,
for diabetics in place of the tiny
razors, called lancets.
It is now being used
to prick the finger to
obtain a drop of blood. The
laser is a step towards more
pain-free testing. Diabetics can use
this device at home to test
their blood test without the pain of pricking
their fingers. Care should however
taken to ensure that
children do
not fiddle
with it as it's powerful light beam can
harm them.
Their
Limitation
In
spite of these advances in glucose monitoring,
it continues to remain a problem for many
patients.
Intermittent capillary blood monitoring
provides only a snapshot and not the true
trends in fluctuations of blood glucose
levels. Many patients are reluctant to monitor
as often as they probably should because
of the inconvenience, pain, and the expense.
Thus it is often difficult for both healthcare
providers and patients to make appropriate
adjustments in treatment regimens on the
basis of available information.
Continuous
Glucose Monitoring Devices
To
overcome problems related to the availability
of
adequate data, devices are
being designed that make it feasible for
both
physicians and patients to obtain continuous
glucose readings. They include:
¨
Interstitial
Fluid Monitoring System.
Its brand name is Mini Med Continuous Glucose
Monitoring System –CGMS
¨
The
Gluco Watch–A
wristwatch–style device worn on the forearm.
While
daily blood glucose testing tells you what
your blood sugar level is at the time you
test, HbA1c test tells you your ‘average’
blood sugar level over the past 2-3 months.
Both tests are very important in protecting
your long-term health. Maintaining good HbA1c
levels will help reduce your risk of diabetes
complications. Conventionally, this test was
done in a lab.
