Diabetes monitoring, an easier way to keep track of my numbers.

Diabetes is a terrible disease that affects more than 29 million Americans. It is manageable, but requires life style changes and close follow up from medical care providers.

The main parameter used to assess ongoing blood sugar control is the dreaded glucose monitoring (or self monitoring of blood glucose – SMBG) which requires patients to “prick” their finger and take a small blood sample, which is analyzed using a glucose meter. Patients are instructed to keep records/ logbooks of their readings along with other relevant information (such as how much food they ate or how much medicine they took). Theoretically the patient would share this information with their medical providers, who in turn would use it to make treatment adjustments (adjust diet, recommend exercise, and adjust insulin doses).

Patients usually have an established plan that guides how much and when they eat, how much insulin they take, and any other behaviors. But patients are not always fully adherent to these treatment plans - or at least not as diligent about the plan as they should be. And during periods when there may be dietary indiscretion, illness, or inactivity, they often require considerable support and guidance from their care team. Providers do not have a great deal of time or information at the point of care (visit) – and easy access to accurate data is a huge help. Commercially available glucose meters provide the basic blood glucose values. The basic meter will give a reading of the blood sugar and most have the ability to store information. Transcribing the information is generally done by the patient often manually and kept in a logbook.  The accuracy and completeness of the entries depends on the individual. And how the information is relayed to and interpreted by the healthcare team is also an issue. Some patients in an effort not to displease the medical provider and demonstrate that they are diligent in keeping the log may enter results of missing data points from memory after the fact or even all at once just before a visit. This does not help the patient or the provider.

The American Diabetes Association (ADA), on their website www.diabetes.org, has a basic log sheet to help guide record keeping. The logs are simple and provide the basic information needed to guide care.

But some logs can contain varying number of data points with some being quite complex (and can include: calories consumed, carbohydrate ratio, and even calorie expenditure during exercise). It is demanding and even tedious to keep track of and manually record all the data points that are required to produce a meaningful report. The glucose meters that provide the information are often nominally priced or may even be free, but there is an ongoing cost for the supplies such as test strips and reagents. The cost of these items can be considerable. If patient uses a branded (not generic) meter the cost of the strips could be substantial, whereas if the patient switched to a generic meter, the cost of strip could be significantly less. Patients will generally not switch meters for one of two reasons - insurance coverage or lack of access to data (if you switch meters you may no longer have access to your stored data).

A new concept in monitoring is emerging, which uses personal electronic devices such as smart phones to monitor store and collate data. The software (app) can upload the information to the smart phone, which is then formatted and used to help patients better understand how their actions impact their blood sugar levels, and by medical providers to better customize care to the needs of individual patients.  One such system is the Ditto Glucose Data System. This system is comprised of an FDA registered, class 1 medical device with HIPPA compliant storage and a mobile application. I think this device and ones like it will be the standard of care in the near future. The ditto-mobile app allows patients to review and track blood glucose results and add behavioral context and photos. Patients test normally, as directed by their health care provider. With ditto results from multiple meters can be put in the same report - or if one uses multiple meters - the data will not be lost. Therefore the patient has the option of using any meter – which could bring down cost of testing supply’s considerably. However the aim is to simplify the monitoring of diabetes through ditto’s sync, track, and share methodology. One can set high and low ranges, for various parameters and add context such as how much food you eat, or when you exercise, and review data in log book or calendar views. This information is shared with the healthcare team. And if the patient wants to use multiple meters all data will be in a single report.

Diabetes and its many complications remains a serious disease. It can be managed; however, the appropriate diet along with exercise and medication - as recommended by ones medical care team - is the key to maintaining control over the disease and avoiding complications. Consistent self-monitoring of blood sugar levels and management with systems like ditto is key in that effort. It cannot be over emphasized, however, that lifestyle changes (diet and exercise) are the corner stone of care.