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Diabetes Monitor
Diabetes Forecast article
By Debra Gordon
Submitted 6-5-01
You might say Kevin Kaplan is glucometer obsessed. The Miami attorney has five machines -- in his car, his office,
his house, his wife's car, and his briefcase. He needs that many, he says, because he tests his blood four to eight
times a day. Tracking the results that emerge from all that testing would be enough to give even the most data-obsessed
accountant a headache, but Kaplan has found a way. Every couple of weeks, he hooks his meters up one by one to
his computer, presses a button, and voila! All data appears one easy-to-read chart, pie chart or bar graph.
Sure beats a manual logbook.
Yet less than 1 percent of people with diabetes use meter software, says San Diego endocrinologist Tim Bailey,
M.D., an assistant clinical professor at the University of California, San Diego. That's a shame, he notes, since
they're missing out on something that could help them organize and track their glucose readings -- and thus better
manage their diabetes -- in much the same way programs like Quicken help organize and track your personal finances.
"It's a crime that software to record and analyze the mountain of data that is generated from glucose pokes
has not been widely available and adopted," he says.
The small numbers are even more surprising when you consider that the technology has been around since the 1980s.
Of course, very few people had personal computers back then, notes Dr. Bailey. But today, when more than half of
all American households have computers, when we use PCs for everything from paying bills to booking trips to developing
pictures, you'd think their integration into diabetes management would be a no brainer. Not so. For there are still
too many barriers, says Dr. Bailey.
They include:
- Equipment. You need cables to connect the meter to your computer. These have to be purchased separately and cost
about $20.
- Software. Although several manufacturers make their software available free of charge on the Web, if you buy
it separately it can cost between $20 and $100.
- Change. If jotting down figures in your logbook has become as automatic as putting on your seatbelt, adjusting
to a new routine can be difficult.
Chris Falk understands this last barrier well. When the 38-year-old public relations professional from Chevy Chase,
Md., switched to a programmable Accu-Chek® unit with "all the bells and whistles" when his old ExacTech
meter died, he deliberately ignored many of the functions that came with the meter, including the software and
cable. "What I enjoyed most about my non-programmable ExacTech unit was its simplicity," he says. "I'm
the type of person/diabetic for whom convenience is a key issue in monitoring. I'm embarrassed to admit it, but
the more cumbersome and complex sugar monitoring becomes, the less likely I am to do it on a regular basis. If
I have to track down an adapter, load computer programs, enter data, etc., in order to monitor, I'm going to think
twice about doing it."
Just this perception of difficulty creates yet another barrier, notes Janis Roszler, R.N., CDE. In reality, she
says, downloading information from your meter to your computer is generally as simple as hooking up a cable and
pressing a button. But even that, she says, requires more computer savvy than many people -- particularly older
diabetes patients -- have. "Just to know how to use the meter itself is often enough of a challenge,"
she says. Also, she says, "many people are just not as interested in being that hands on with their diabetes."
Then there's the fact that the software meter companies sell is designed to work with just one manufacturer's meters
-- and people with diabetes have an average of 2.5 meters, not always from the same company, says Dr. Bailey. "And
then what if you change the type of meter you're using? Where are you going to get the history of data from?"
There are software programs available that work with a variety of meters -- Dr. Bailey developed one himself --
but they are expensive and technical support may be dicey since many companies that initially developed them have
been sold or gone out of business.
So why bother at all?
"It goes back to the old phrase, a picture is worth a thousand words," says Kim Kelly, Pharm.D., director
of diabetes programs for Lifescan, which makes the IN TOUCH™ Diabetes Management Software meters. "The computer
can help you look at your information in a very different way. It can show you patterns."
"I see people who test meticulously and put it in the logbook, but who don't self-analyze and reflect,"
says Paul Lock, M.D., a clinical endocrinologist based in Wooster, Mass. "My take is if they put it on the
screen, the patterns become clear and then that information can be shared with health professionals and patients
will be more interactive with their health professionals."
For instance, most meter software displays information in brightly colored pie charts and bar graphs as well as
logbook formats. And when the proverbial piece of the pie representing your target rate is simply a sliver, there's
no hiding from the fact you've got a problem. Try getting that image from a week's worth of logbook figures.
Other neat features available on most meter software includes:{Andrew: I recommend graphics/pictures of these;
I know the meter companies would send you what you need.
- Modal readings, which present all the readings as if they occurred on the same day, so you can clearly see where
your problem times lie.
- Physician tracking fields, which let you input your doctor's modem number and email so you can send the information
directly to his or her office.
- The ability to average glucose readings by time of day, mealtime, even day of week.
Yet all the charts in the world aren't going to make a difference if your physician isn't involved in helping you
analyze them and make the necessary changes in your diet, medications and exercise, says Dr. Lock. "Technology
can leverage productivity and modify behavior," he says. "But no technology will succeed without the
human element. So the next step is to not only have the pie graph in the hand of the person with diabetes, but
to have the ability to transmit that graph for observation, assessment, encouragement and advice to the physician."
But again, barriers arise. Many physicians either don't use the software themselves, or only have one or two types
on their own computers. Plus, evaluating the results requires more time during visits, says Dr. Bailey. "The
stereotypical patient brings in the log book, the doctor recoils, flips through it, hands it back and says 'you're
doing great,'" he notes. If, suddenly, you're handing your physician neatly formatted graphs and charts, he
says, your doctor may have to spend more time with it -- time for which there is no additional payment.
Greater involvement from physicians may come if the meter companies conduct studies to show that using the software
can really improve diabetes management. But no such studies have been done or are currently planned. "We definitely
need to be doing studies," admits Kelly.
Manufactures also need to consider how to integrate meters with the wireless technology available on personal digital
assistants (PDA) such as Palm Pilots, says Arizona editor Vickie Gaubeca. Gaubeca has had Type 1 diabetes for 22
years and has an insulin pump. She also has a Handspring Visor PDA. She enters her blood glucose levels manually
into a program on her Handspring, along with her carbohydrate intake and amount of insulin, then uses the software
to view graphics similar to those offered with meter software. But she doesn't use the meter software that came
with her glucometer, she says, because that would tether her to her computer, and she's constantly on the go.
Her fantasy? "A glucometer with an infrared device that allows me to download blood glucoses into my PDA,
or a glucometer that enables me to input carbs and glucose and see averages and trends," says Gaubeca, a self-proclaimed
"gadget-phile."
"Do you think," she asks hopefully, "I could be a beta tester for one of the meter companies?"
SIDEBAR
Buying a Meter and Software
As diabetes educator Janis Roszler notes, people don't choose maters based on their ability to download information
to the computer, but on their accuracy, size, amount of blood they require, ease of use, etc. Still, when buying
a meter that works with software, here are some things to find out and look for:
- What will it cost to connect to the computer (price of cable/software)?
- What is the return policy if it doesn't perform as you expect it to?
- What functions does the meter have (what type of other data does it
record)?
- What kind of information will it store? It should store blood sugar, food intake, activity, medication dosage,
she says, so you can see cause and effect, not just raw data.
- How much data will it store? Ideally, it should store at least a month's worth.
For more detailed information on meter software, check out the following web sites, which evaluate several types
of software:
http://www.childrenwithdiabetes.com/d_06_150.htm
www.mendosa.com/software.htm
SIDEBAR TWO:
Here is a list of meters that interact with computer software, as well as where you can find information about
cables.
ABBOTT
Precision QID
MediSense Precision Xtra
MediSense Companion 2
Customer Service: (800) 527-3339
BAYER
DEX
Glucometer Elite XL
Glucometer Store Online: http://www.glucometerstore.com/
Customer Service: (800) 255-3232
LIFESCAN FastTake
One Touch Basic
One Touch II
One Touch Profile
One Touch Ultra
SureStep
Buy online for $19.99 from Drugstore.com
Learn more about LifeScan Interface Cables:
http://www.lifescan.com/lsprods/interface_cable.html
LXN
ExpressView
InCharge
Web Site: InChargeNow.com
Customer Service: (888) 596-8378
Email Customer Service: incharge@inchargenow.com
ROCHE
Accu-Chek Complete (US)
Accu-Chek Advantage (US)
Customer Service: (800) 858-8072
Roche US Web Site: http://us.diabetes.roche.com
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