Helping Patients Help Themselves

• By David Kopf
• Sep 01, 2008

How providers can use advances in diabetes supplies to help ensure compliance.

The U.S. diabetes population is a patient demographic that is impossible to ignore. According to the American Diabetes Association there are 23.6 million Americans with diabetes — that’s 8 percent of the population. Nearly any provider can pretty much assume that its local area contains a sizeable number of patients that need diabetic supplies.

In fact, they might already be serving them and not realize it. For instance, if a provider is serving bariatric patients, it can safely conclude that a portion of them might also suffer from diabetes.

Moreover, given the need for patients to monitor their blood glucose — and the tendency for some patients not to self-monitor — providers could work with local referral partners to help increase their compliance.

The reasons why patients don’t self-monitor are varied. A 2002 study from the Diabetes Research Group of the Department of Internal Medicine at the University of Manitoba, Winnipeg found that “at entry patients indicated that they were not self-monitoring more often because testing was not convenient (47 percent), strips were too expensive (31 percent), they could feel their own blood glucose without testing (21 percent), testing was too painful (14 percent), or testing did not help (10 percent).”

Another more recent study of 180 newly diagnosed Type 2 sufferers that was conducted in the United Kingdom found that those patients who self-monitored had a 6 percent higher score for depression. That figure might initially raise eyebrows, but given the massive gear-change that diabetes represents for the newly diagnosed, it’s not necessarily that startling.

“Diabetes itself is stressful,” says Kathy Ahearn, RN, BSN and PHN, who has worked with many diabetic patients, is the mother of a daughter with type 1, and also is the director of managed care for glucometer manufacturer Arkray USA. “[Patients] have to completely change their lifestyle.”

Fortunately, the makers of diabetic supplies have responded with solutions that address many of those complaints, as well as other factors.

Less Is More
To begin with glucometers are now much smaller and lighter, and less obtrusive. Having a small piece of medical equipment that drops into a pocket as easily as a cell phone is an obvious plus in the convenience column, but it also reduces any self-consciousness a patient might feel when testing.
This could be especially beneficial on the playground, where “kids don’t want to stick out and be different,” Ahearn says.

Bearing that in mind, not only are glucometers getting as small as cell phones, they’re actually starting to look like them. Manufacturers are now making glucometers that look like small personal electronic items, such as cell phones or electronic games. That’s a welcome bit of campus camouflage for any child who might be feeling self-conscious.

That “less is more” philosophy is also playing out in the sample size needed to take an accurate reading. Smaller lancets mean less, or virtually no pain, and very small sample sizes ranging from .5 microliters to 1.5 microliters.

Moreover, alternate site testing is another development in diabetic supplies that is reducing anxieties over taking a sample. (Those worries over pain aren’t limited to the newly diagnosed, either.) Instead of having to prick a fingertip — the area of the body that has the highest concentration of nerve endings — many glucometers now let patients take samples on their forearms, palms and other areas of the body that aren’t as sensitive.

That said, the fingertip also is the best access point for reaching capillaries, so alternate site testing can conversely cause variations in readings.

Keeping it Simple — and Cheap
And when a sample that is taken is too small, many glucometers now offer double-dosing features. When, on the first try, a patient doesn’t get enough blood on a strip to get an accurate reading, the glucometer can let the patient add a little more blood to the strip.

This is important considering that testing strips are a cost that can add up for patients. Not having to throw away a strip because of a sample that was initially too small is a definite cost saver.

So are longer lasting strips. Strips have a finite shelf life, and the advent of test strips that last longer will cut down on waste.

Strips are also getting smarter, as are glucometers. Possibly one of the most important developments in glucometers for increasing convenience, cutting confusion and advancing compliance is auto coding.

Glucometers need to be calibrated to the type of strip being used in order to take accurate readings. This has required patients to enter codes into the device .With auto coding, the strip contains the code and the glucometer automatically reads it and keys to that code when the patient inserts the strip. This is a major step forward in convenience and simplicity.

Adapting to life with diabetes can represent a major hurdle for patients, but advances in diabetic supplies represents a major opportunity for providers to help them smooth that transition.

This article originally appeared in the September 2008 issue of HME Business.