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<ul><li>The Reality of Diabetes Care </li></ul><ul><li>Terri Sasse, RN, CDE </li></ul>
 
Agenda <ul><li>Diabetes Overview </li></ul><ul><li>Patient Monitoring of Blood Sugar  </li></ul><ul><li>Features and Benef...
Program Information ACPE # 384-000-07-017-L04 Release Date: 8-6-07 Expires: 8-6-2010 STAT Educational Services, a division...
Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>Know data of the prevalence and incidence of diabet...
Diabetes Prevalence <ul><li>20.8 million people have diabetes </li></ul><ul><li>6.2 million are undiagnosed </li></ul><ul>...
Diabetes Incidence
Trends in Growth <ul><li>Aging population </li></ul><ul><li>Increase in overweight population </li></ul><ul><ul><li>Adults...
Evolution of Glucose Testing <ul><li>1948-Urine testing strips developed using glucose oxidase as enzyme </li></ul><ul><li...
BG Meter Technology-1970’s <ul><li>Color Reflectance or Reflectance Photometry </li></ul><ul><ul><li>Chemical reaction bet...
Current Technology Segmentation 75% 25% <ul><li>Photometric – 25% </li></ul><ul><ul><li>Lifescan  Basic/Profile/Surestep <...
Benefits of Self-Monitoring <ul><li>Benefits both Type 1 and Type 2 patients with diabetes </li></ul><ul><ul><li>DCCT Type...
Importance of BG Monitoring <ul><li>Cornerstone of diabetes self-management </li></ul><ul><li>Individualizes diabetes self...
Frequency of Testing <ul><li>Type of Diabetes </li></ul><ul><li>Overall glycemic control </li></ul><ul><li>Changes in ther...
ADA Guidelines for Testing <ul><li>As needed to achieve glycemic goals </li></ul><ul><li>Fasting </li></ul><ul><li>Prepran...
AAFP Guidelines for Testing <ul><li>Type 1 taking insulin- </li></ul><ul><li>test 3-4x day </li></ul><ul><li>Type 2 taking...
What are the goals? <ul><li>ADA recommendations: </li></ul><ul><ul><li>Preprandial plasma glucose  90-130mg/dL </li></ul><...
Measures of Glycemic Control <ul><li>Self-monitoring (SMBG) </li></ul><ul><li>Glycosylated hemoglobin </li></ul><ul><ul><l...
Advantages of Monitoring   <ul><li>Immediate results </li></ul><ul><li>Evaluation of changes </li></ul><ul><li>Enhanced pa...
Relationship between HbA 1c   and Average Blood Glucose (DCCT)* <ul><li>%HbA1c </li></ul><ul><li>Average BG </li></ul>High...
Elevated Postprandial Glucose Levels <ul><li>Earliest abnormality in type 2 diabetes </li></ul><ul><li>Contributes to elev...
Targeting Postprandial and Fasting Glucose Levels Lowers HbA 1c  in Type 2 Diabetes 0% 2% 4% 6% 8% 10% Fasting Alone Fasti...
The Reality of Diabetes Care <ul><li><2% of American adults with diabetes receive optimal quality of care </li></ul><ul><l...
The Right Meter for the  Right Patient
Customer Confusion!
<ul><li>Nearly 50% of meter scripts are not brand specific </li></ul>Unbranded  Meter Scripts *GfK Market Measures Therape...
Patient’s Reasons for Selecting a BG Meter 2006 Roper Global US Diabetes Program at GFK NOP World Health, August – Septemb...
Lowest CoPay Prevalence by Test Strips – Commercial Insurance 05/07 Top Commercial Plans by TRx Volume 19% 12% 8% 9% 51%
Features and Benefits <ul><li>Meter </li></ul><ul><li>Size of meter  </li></ul><ul><li>Test time </li></ul><ul><li>Calibra...
Comparison of Leading BGM Systems 7, 14 - & 30-Day 500 5 seconds 1 microliter One Touch ®  Ultra 2 ® 14- & 30-Day 365 10 s...
Advanced Blood Glucose Monitoring Systems One Touch® Ultra 2® TrueTrack  SmartSystem® FreeStyle ™   Flash ™ Accu-Chek™ Avi...
Information   Blood Glucose   Systems Accu-Chek  ™  Complete ™ FreeStyle ™  Tracker ™ One Touch  ®  UltraSmart ®
Store Brand Offerings TrueTrack Smart System® ReliOn ®  Ultima ™ Kroger ®
Accuracy of Blood Glucose Monitoring Systems <ul><li>FDA Approval process involves showing substantial equivalence between...
Industry Standards for Accuracy <ul><li>FDA recognizes National Committee for Clinical Laboratory Standards 1  </li></ul><...
Variables that can affect the Accuracy  of BGM <ul><li>User Variables </li></ul><ul><li>Poor technique </li></ul><ul><ul><...
Promoting Accurate Testing <ul><li>Review and understand manufacturers “instructions for use” </li></ul><ul><li>Practice u...
Hands-on Experience with Monitors
Helping your Patients <ul><li>Assess the physical needs </li></ul><ul><ul><li>Visual limitations </li></ul></ul><ul><ul><l...
Case Study <ul><li>TS is a patient with Type 2 diabetes who has been self managing with meal planning and physical activit...
Case Study <ul><li>In order to help TS select a monitor, what are 2 things you need to consider?  </li></ul><ul><li>What s...
Conclusions <ul><li>Clinical studies support the benefits of BG monitoring in helping patients achieve glycemic goals </li...
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Reality Diabetes Care

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  • Transcript of "Reality Diabetes Care"

    1. 1. <ul><li>The Reality of Diabetes Care </li></ul><ul><li>Terri Sasse, RN, CDE </li></ul>
    2. 3. Agenda <ul><li>Diabetes Overview </li></ul><ul><li>Patient Monitoring of Blood Sugar </li></ul><ul><li>Features and Benefits of Monitors </li></ul><ul><li>Hands-on Experience with Monitors </li></ul><ul><li>Case Study </li></ul>
    3. 4. Program Information ACPE # 384-000-07-017-L04 Release Date: 8-6-07 Expires: 8-6-2010 STAT Educational Services, a division of National Pharmacy Technician Association Inc., is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.
    4. 5. Objectives <ul><li>Participants will be able to: </li></ul><ul><ul><li>Know data of the prevalence and incidence of diabetes </li></ul></ul><ul><ul><li>Describe the evolution and current technology for measuring blood glucose levels </li></ul></ul><ul><ul><li>Identify the importance of blood glucose monitoring in diabetes management </li></ul></ul><ul><ul><li>Recognize the various features and benefits of commercially available blood glucose monitors </li></ul></ul><ul><ul><li>Discuss how to assist patients in selecting a blood glucose monitoring system </li></ul></ul><ul><ul><li>Understand variables that may affect the performance of blood glucose monitoring systems </li></ul></ul>
    5. 6. Diabetes Prevalence <ul><li>20.8 million people have diabetes </li></ul><ul><li>6.2 million are undiagnosed </li></ul><ul><li>41 million have </li></ul><ul><li>pre-diabetes </li></ul>
    6. 7. Diabetes Incidence
    7. 8. Trends in Growth <ul><li>Aging population </li></ul><ul><li>Increase in overweight population </li></ul><ul><ul><li>Adults </li></ul></ul><ul><ul><li>Children </li></ul></ul><ul><li>Influx of high risk groups </li></ul><ul><li>Increased diagnosis </li></ul>
    8. 9. Evolution of Glucose Testing <ul><li>1948-Urine testing strips developed using glucose oxidase as enzyme </li></ul><ul><li>Limitations: </li></ul><ul><ul><ul><ul><li>qualitative only </li></ul></ul></ul></ul><ul><ul><ul><ul><li>differences in renal threshold </li></ul></ul></ul></ul><ul><ul><ul><ul><li>affected by interfering substances </li></ul></ul></ul></ul><ul><ul><ul><ul><li>poorly correlated to blood glucose </li></ul></ul></ul></ul>
    9. 10. BG Meter Technology-1970’s <ul><li>Color Reflectance or Reflectance Photometry </li></ul><ul><ul><li>Chemical reaction between glucose and an enzyme produces a color change on test strip </li></ul></ul><ul><ul><li>Color change is proportional to amount of glucose in sample </li></ul></ul><ul><li>Electrochemical or Biosensor </li></ul><ul><ul><li>An electrochemical reaction which generates an electrical current proportional to the amount of glucose </li></ul></ul>Accuracy of Blood Glucose Measurement at www.powerpak.com . 2003
    10. 11. Current Technology Segmentation 75% 25% <ul><li>Photometric – 25% </li></ul><ul><ul><li>Lifescan Basic/Profile/Surestep </li></ul></ul><ul><ul><li>Accu-Chek Active/Compact </li></ul></ul><ul><ul><li>Prestige IQ Smart System </li></ul></ul><ul><li>Biosensor – 75% </li></ul><ul><ul><ul><li>Lifescan Ultra </li></ul></ul></ul><ul><ul><ul><li>Therasense Freestyle </li></ul></ul></ul><ul><ul><ul><li>TrueTrack Smart System </li></ul></ul></ul><ul><ul><ul><li>Accu-Chek Advantage </li></ul></ul></ul>
    11. 12. Benefits of Self-Monitoring <ul><li>Benefits both Type 1 and Type 2 patients with diabetes </li></ul><ul><ul><li>DCCT Type 1 </li></ul></ul><ul><ul><li>United Kingdom Prospective Diabetes Study Type 2 </li></ul></ul>ADA Standards of Medical Care in Diabetes, Diabetes Care, Vol. 27, January 2004, pg. S15-S35.
    12. 13. Importance of BG Monitoring <ul><li>Cornerstone of diabetes self-management </li></ul><ul><li>Individualizes diabetes self-care </li></ul><ul><li>Empowers the patient </li></ul><ul><li>Reinforces good behaviors </li></ul>
    13. 14. Frequency of Testing <ul><li>Type of Diabetes </li></ul><ul><li>Overall glycemic control </li></ul><ul><li>Changes in therapies </li></ul><ul><li>Changes in lifecycle </li></ul>ADA Standards of Medical Care in Diabetes, Diabetes Care, Vol. 27, January 2004, pg. S15-S35.
    14. 15. ADA Guidelines for Testing <ul><li>As needed to achieve glycemic goals </li></ul><ul><li>Fasting </li></ul><ul><li>Preprandial/Postprandial </li></ul><ul><li>3 am </li></ul><ul><li>Periodically alternate testing times </li></ul><ul><li>Test when symptomatic </li></ul>ADA Standards of Medical Care in Diabetes, Diabetes Care, Vol 27, January 2004, pg S15-S35.
    15. 16. AAFP Guidelines for Testing <ul><li>Type 1 taking insulin- </li></ul><ul><li>test 3-4x day </li></ul><ul><li>Type 2 taking insulin and orals </li></ul><ul><li>-test 3-4x/day </li></ul><ul><li>Orals only with A1C out of target range-test 2-4x/day </li></ul>American Academy of Family Physicians, 2004
    16. 17. What are the goals? <ul><li>ADA recommendations: </li></ul><ul><ul><li>Preprandial plasma glucose 90-130mg/dL </li></ul></ul><ul><ul><li>Postprandial plasma glucose <180mg/dL </li></ul></ul><ul><ul><li>A1C <7% </li></ul></ul><ul><li>All goals are individualized </li></ul><ul><li>Based on certain populations </li></ul>ADA Standards of Medical Care in Diabetes, Diabetes Care, Vol 27, Jan 2004, pg. S15-S35.
    17. 18. Measures of Glycemic Control <ul><li>Self-monitoring (SMBG) </li></ul><ul><li>Glycosylated hemoglobin </li></ul><ul><ul><li>Total hemoglobin </li></ul></ul><ul><ul><li>Hemoglobin A 1c </li></ul></ul><ul><li>Urine ketone testing </li></ul>
    18. 19. Advantages of Monitoring <ul><li>Immediate results </li></ul><ul><li>Evaluation of changes </li></ul><ul><li>Enhanced patient independence </li></ul><ul><li>Marker of glycemic control </li></ul><ul><li>Evaluation of self-monitoring </li></ul><ul><li>Correlation with long-term complications </li></ul>SMBG Glycosylated Hemoglobin
    19. 20. Relationship between HbA 1c and Average Blood Glucose (DCCT)* <ul><li>%HbA1c </li></ul><ul><li>Average BG </li></ul>High Risk for Complications Good Control Low Risk for Complications Normal Range Low Risk for Complications 330 300 270 240 210 180 150 120 90 60 13 12 11 10 9 8 7 6 5 4
    20. 21. Elevated Postprandial Glucose Levels <ul><li>Earliest abnormality in type 2 diabetes </li></ul><ul><li>Contributes to elevations in HbA1c </li></ul><ul><li>Best predictor of HbA1c </li></ul><ul><li>Contributes to both microvascular and macrovascular complications </li></ul>
    21. 22. Targeting Postprandial and Fasting Glucose Levels Lowers HbA 1c in Type 2 Diabetes 0% 2% 4% 6% 8% 10% Fasting Alone Fasting Plus Postprandial HbA 1 c 9.4% 7.1% 24% Reduction Ohkubo Y, et al. Diabetes Res Clin Pract . 1995;28:103-117.
    22. 23. The Reality of Diabetes Care <ul><li><2% of American adults with diabetes receive optimal quality of care </li></ul><ul><li>Majority of patients with Type 2 diabetes have only fair to poor metabolic care </li></ul><ul><ul><li>Fasting glucose levels of 200mg/dL or higher </li></ul></ul><ul><ul><li>HbA1c levels of 9-10% (<7% is target) </li></ul></ul><ul><li>Postprandial glucose levels average 300mg/dL </li></ul><ul><li>Beckles, GL., et al. Diabetes Care , 1998:21:1432-1438; ADA, Diabetes Care , 1998:21(supple 1); Colwell JA. Ann Intern med. 1996:124 (1pt2):131-135; Abraira C, et al. Diabetes Care . 1992;15:1560-1571; Klein R, et al. Am J Epidemiol. 1987;126:415-428; CowieCC, et al. Diabetes in America. 2 nd Edition </li></ul>
    23. 24. The Right Meter for the Right Patient
    24. 25. Customer Confusion!
    25. 26. <ul><li>Nearly 50% of meter scripts are not brand specific </li></ul>Unbranded Meter Scripts *GfK Market Measures Therapeutic Class Studies Blood Glucose Monitoring Study V (2005) - ** GfK Market Measures Roper 2006 US Diabetes Patient Market Study
    26. 27. Patient’s Reasons for Selecting a BG Meter 2006 Roper Global US Diabetes Program at GFK NOP World Health, August – September 2006 47% 13% 6% 18%
    27. 28. Lowest CoPay Prevalence by Test Strips – Commercial Insurance 05/07 Top Commercial Plans by TRx Volume 19% 12% 8% 9% 51%
    28. 29. Features and Benefits <ul><li>Meter </li></ul><ul><li>Size of meter </li></ul><ul><li>Test time </li></ul><ul><li>Calibration or coding procedure </li></ul><ul><li>Data management options </li></ul><ul><li>System specifications </li></ul><ul><li>Test Strips </li></ul><ul><li>Size of test strips </li></ul><ul><li>Packaging of test strips </li></ul><ul><li>Amount of blood required </li></ul><ul><li>Blood sampling sites </li></ul>
    29. 30. Comparison of Leading BGM Systems 7, 14 - & 30-Day 500 5 seconds 1 microliter One Touch ® Ultra 2 ® 14- & 30-Day 365 10 seconds 1 microliter TrueTrack ® 14-Day 250 7 seconds 0.3 microliters Freestyle ® Flash® 14-Day 480 5 seconds 0.6 microliters Ascensia ™ Contour ® 7, 14- & 30-Day 500 5 seconds 0.6 micorliters Accu-Chek ™ Aviva ® Averaging Test Memory Test Speed Sample Size Required Data Management Test Strips
    30. 31. Advanced Blood Glucose Monitoring Systems One Touch® Ultra 2® TrueTrack SmartSystem® FreeStyle ™ Flash ™ Accu-Chek™ Aviva™
    31. 32. Information Blood Glucose Systems Accu-Chek ™ Complete ™ FreeStyle ™ Tracker ™ One Touch ® UltraSmart ®
    32. 33. Store Brand Offerings TrueTrack Smart System® ReliOn ® Ultima ™ Kroger ®
    33. 34. Accuracy of Blood Glucose Monitoring Systems <ul><li>FDA Approval process involves showing substantial equivalence between the investigative device and a device that is currently on the market </li></ul><ul><li>FDA requires Human Factors Studies </li></ul><ul><li>International Standardization Organization </li></ul>U.S. FDA –Center for Devices and Radiologic Health, 1997, Guidance Glucose Document
    34. 35. Industry Standards for Accuracy <ul><li>FDA recognizes National Committee for Clinical Laboratory Standards 1 </li></ul><ul><li>ADA goal: +/- 10% at ranges 30-400mg/dL 2 </li></ul><ul><li>Clinically acceptable is +/- 15% of the standard laboratory value 3 </li></ul><ul><li>“ Most patients with some formal training can obtain results within 20% of the lab reference” 4 </li></ul><ul><li>Most meter result errors are user related 5 </li></ul><ul><li> </li></ul><ul><li>1 NCCLS Method Comparison and Bias Estimation Using Patient Samples </li></ul><ul><li>EP9-A Vol. 15 No. 17 </li></ul><ul><li>2 ADA Consensus Statement. Diabetes Care 1987; 1:95-99 </li></ul><ul><li>3-5 Ibid. </li></ul>
    35. 36. Variables that can affect the Accuracy of BGM <ul><li>User Variables </li></ul><ul><li>Poor technique </li></ul><ul><ul><li>-27%-48% poor vision </li></ul></ul><ul><ul><li>-25% loss of sensation </li></ul></ul><ul><ul><li>-language constraints </li></ul></ul><ul><ul><li>-insufficient sample size </li></ul></ul><ul><li>Soiled meter </li></ul><ul><li>Lack of calibration </li></ul><ul><li>Lack of hand-washing </li></ul><ul><li>System Variables </li></ul><ul><li>Heat or Cold </li></ul><ul><li>Defective Strips </li></ul><ul><li>Humidity </li></ul><ul><li>Pharmacological Factors </li></ul><ul><li>Oxygen content </li></ul><ul><li>Glucose content (60-200mg/dL) </li></ul><ul><li>Dehydration </li></ul><ul><li>Interfering Substances </li></ul>Accuracy of Blood Glucose Measurement. Available at http://www.powerpak.com/CE/accuracy_bgm/pharmacy /references.cfm
    36. 37. Promoting Accurate Testing <ul><li>Review and understand manufacturers “instructions for use” </li></ul><ul><li>Practice using control solution </li></ul><ul><li>Assess user technique </li></ul><ul><li>Understand system specifications </li></ul><ul><ul><li>Proper storage and maintenance </li></ul></ul><ul><ul><li>Limitations of procedure </li></ul></ul><ul><li>Utilize manufacturer technical support </li></ul>A Core Curriculum for Diabetes Education, 5 th edition, AADE, Chicago, IL
    37. 38. Hands-on Experience with Monitors
    38. 39. Helping your Patients <ul><li>Assess the physical needs </li></ul><ul><ul><li>Visual limitations </li></ul></ul><ul><ul><li>Dexterity limitations </li></ul></ul><ul><li>Assess the financial needs </li></ul><ul><ul><li>Cash or reimbursement </li></ul></ul><ul><li>Assess the lifestyle needs </li></ul><ul><ul><li>Active vs. Sedentary </li></ul></ul><ul><li>Assess the plan of care </li></ul><ul><ul><li>Frequency of testing </li></ul></ul>
    39. 40. Case Study <ul><li>TS is a patient with Type 2 diabetes who has been self managing with meal planning and physical activity. Her labwork showed an A1c level of 9% and her physician has referred her to a diabetes educator so that she can learn about BG monitoring and how her daily choices affect her glucose results. TS has poor vision, arthritis and is very afraid of sticking herself to get blood for a BG test. </li></ul>
    40. 41. Case Study <ul><li>In order to help TS select a monitor, what are 2 things you need to consider? </li></ul><ul><li>What specific features and benefits should you look for in a monitoring system to assist TS in selecting a meter? </li></ul>
    41. 42. Conclusions <ul><li>Clinical studies support the benefits of BG monitoring in helping patients achieve glycemic goals </li></ul><ul><li>Optimal diabetes control helps to delay or prevent complications </li></ul><ul><li>Manufacturers focus on designing meters that are easy to use </li></ul><ul><li>and meet individual lifestyle needs </li></ul><ul><li>When used according to instructions, blood glucose monitoring </li></ul><ul><li>provides valuable information for managing diabetes care </li></ul>
    42. 43. Questions/Comments
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