Tuesday, July 25, 2006

Gadgetry for Better Diabetes Control

There is no doubt that good control of diabetes (blood sugar control), reduces the microvascular and macrovascular complications like nephropathy, retinopathy, coronary artery disease and strokes. This was well shown in the UKPDS study and DCCT study.

We have always depended on spot fasting sugar checks as a home testing and clinic checking. This test is a point of site, dry chemistry test, which gives results in 20-30seconds. We also know from the UKPDS study that the Hb A1c (glycosylated hemoglobulin) levels are also predictors of good clinical outcome in diabetes management. A HbA1c level of 7 or below is good control. For along time, measurement of HbA1c was always a laboratory test and results would take a few hours to be read.

Bayer Healthcare has now come out with a point of care, dry chemistry test that takes 5 mins to read from a finger prick drop of blood. The test is fairly reliable with good correlation to the laboratory test, but is not exactly equivalent, meaning that there is good intra-observer kit accuracy but not so good inter-observer kit accuracy. Each machine may have to be repeatedly calibrated (the biggest problems with such dry chemistry kits) for continual accuracy.

Yet this kit is welcome, in that a patient now can have his/her own lab at home, to help with better monitoring, and also better DM diagnosis. Of course what I do not know now is what is the cost for each machine and what is the cost of consumables. That will decide how much it will cost to the enduser and how popular and useful that machine will ultimately be. Nonetheless, I am sure that it will be a very useful adjunct for better diabetes management.

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