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Glucometers: How educators and patients choose

May 26, 2015

Why am I thinking about glucometers? Well, first, I was thinking about the upcoming Annual Meeting in San Antonio, and I realized the immense array of booths and vendors which will be present. I got excited thinking about the new “gadgets” which might make an appearance. I then started thinking about glucometers our patients use and the influence we have on the selection. Patients often come in requesting a prescription for the new slick, colorful, quick, reliable glucometer.

I will be honest...I do have my favorites. Then there are the ones I cringe at the mere mention or sight of them. I try not to be biased, but it's difficult when I know about glucometers that provide inaccurate readings and thus place individuals' lives at risk. Then there the many glucometers left by sales representatives in the clinic. I often feel bad accepting them knowing I won't give them to patients. I am also embarrassed to say I don't even know how much glucometers or the supplies cost but I do know some patients limit the testing due to the cost of the reagent strips.

Glucometer selection is a very important part of diabetes management and many factors need to be taken into account to accommodate the limitations often imposed by complications associated with diabetes. When helping patients select a glucometer, the first thing I take into consideration is the reputation and safety of the unit. Then, I assess for sight and manual dexterity issues. The sight limitation is easy to address, but I often have trouble addressing manual dexterity issues. I wonder if anyone has a solution for this one.

Also, I don't encourage alternate site testing due the the lag time and in fact discourage patients from using it when they inquire about it. How about you? Do you have an opinion about this?

How many of you are involved in glucometer selection for patients, and what is the process you use to match the patient with the glucometer?

12 comments

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  1. Jul 14, 2010

    I agree with Iris about the lack of encouraging alternate site testing (AST). Many times patients are sadly disappointed when what they hear on television and what they interpret are totally different. Many patients ask me, "I want to use that meter that you can use and you don't stick yourself". Now go back and re-read what I just wrote. They are under the impression there is no "sticking" going on. Then I explain that they have an option to stick their palm, forearm, etc.. I clarify their misinterpretation, demonstrate how to do the AST, and you should then see the look on their face. Many will then say, "I think I will continue using my fingers". For young, eager, and those with excellent dexterity - AST could be taught and done correcty. I take it patient by patient. After all, I think we have all had some patients that you are doing good to be able to teach fingerstick technique, and teaching them about doing Controls is a whole different scenario. Thank you television...as long your ads are created that create interest among patients (providing fuel for their questions), CDE's will be providing education for a while to come.
  2. Jul 07, 2010

    Variability in BG readings due to poor technique can be a greater issue than the meter accuracy for some patients, but I do wish the regs would be tightened to remove a few glucometers from the market. The Wavesense models purport to have improved accuracy and precision. My patients or their clinics choose the meter brand, usually based on cost of the strips since the meters are often free.
  3. Jul 03, 2010

    Like everyone I've my favorite glucometer, which I chose because of purported accuracy. I look forward to seeing an improvement in accuracy standards. The current standard where 95% of the readings above 75mg/dl are within 20% of the actual reading is abysmal. One point about alternate site testing. A glucometer only gives a point in time reading. The alternate site lags the readings at the finger tips, I'd never use one all the time. If I test using a finger site and I'd like to know the direction my blood glucose is going in, the alternate site test can give some indications. It's not a CGM, but it is additional information.
  4. Jul 03, 2010

    I work in a community with patients who have low income,are uninsured,or underinsured and who also at times have literacy issues. The selection of glucometers are usually based on the meter covered by the members insurance as most of these members cannot afford to purchase glucometers of there choice. There are tmes when I have spoken to providers to select a glucometer that is simple yet accurate, I have had patients who have mental challenges and cannot after multiple return demonstrations and follow-up phone calls successfully use a machine with multiple steps. We do have the Drug Reps who stop by and donate Glucometers which we primarily give to the uninsured patients and then the issues becomes how do they purchase additional test strips. There are a few Glucometers that I prefer due to ease of use and accuracy and whenever I can I do encouraged patients to use these machines, We also have several vendors one in particular that delivers the Glucometers and instruct patients on how to use and provide f/u assist with this when needed which is an added incentive for those who are insured.
  5. Jul 02, 2010

    I work for the VA, so for most of my patients, the meter is chosen for them, the Accuchek Aviva. For most of them the meter does not present problems for vision ( fairly large numbers). As far as dexterity issues, getting strips out of the bottle can be difficult. When I worked for a Non VA health system, we had a selection of free meters supplied by the sales reps. For the person who asked about getting more brands of meters, I would suggest that you contact the companies you are interested in and ask them to have a rep call you. I always have considered the patient's health insurance requirements first. Then if there were choices open to the patient, then helped the patient make a choice based on dexterity, appearance and size of the meter, and the number of steps involved in testing. Presenting too many options to the patient could be over whelming, so I tried to guage how many choices to give him or her. Some patients wanted to see every thing I had in my closet and others said "just give me the easiest one." I agree that I some times would cringe when I was given meters from companies that I was not going to use. Some times after I would go to a convention, I would get free meters in the mail. After a few years, I would throw away. Very wasteful. Alternative site testing is promoted heavily in the media by the companies, but not done very much in my patient's experience.
  6. Jun 30, 2010

    This comment and question was posted by Lori Mauer in a previous post. I thought it was appropriate for this blog. Does anyone have suggestions? One of the most common issues I face pertains to testing time and frequency. The majority of my patients are Type 2 and when they are initially diagnosed they are not using insulin. I would like to know what other eductors are suggesting for a testing schedule for these particular patients. Does anyone have a great testing flow sheet? Thanks
  7. Jun 29, 2010

    I first consider insurance and ease of using devices. I do get frustrated by adds promoting painless testing. People feel they don't have to stick them selves. They think there are different options. Regarding alternate site testing- sometimes it is difficult to get people to test, so if this is the only option I feel it is better than nothing. Although I do request that they inform the provider that they are using alternate sites.
  8. Jun 29, 2010

    I agree with you on alternate site testing. I tell patients that companies say it is OK, but I don't recommend it, because the readings are so different from finger sticks, and this is the most accurate reading. Most of my patients already have monitors. I use the same reasoning that you use to help them attain a monitor that will work for them. I work in a small rural hospital, and usually only have the Free Style Lite to give to patients. How do you go about getting other monitors?
  9. Jun 29, 2010

    It seems the Accu Chek Aviva is pretty popular amongst you guys. Sonia, I'm so glad you brought up the problem with Raynaud's; I haven't encountered a patient yet with this condition. Someone had previously asked on another blog about a good glucometer for patients with dexterity issues. I hope she is reading this blog. I am interested in hearing from individuals who work with children or teenagers and their glucometer choices.
  10. Jun 28, 2010

    I try to let the patient choose, and will guide if formulary an issue. As far as alternate site testing, if compliance is an issue for testing at all, I promote alternate site testing for pre-meal assessment. Would rather some numbers than none at all. Dexterity issues I might favor the accucheck compact, or even the contour for the easy open lid and wider strips. Accucheck Aviva also nice for the multiclix- no handling of tiny lancets. Alot of women like the one touch mini or freestyle lite for size in a purse. When cost is a concern, I refer to the walmart reli-on- made by medisense, AKA the precision. The strips are almost 50% less in cost and are helpful for the self pay. Happy to see the meter companies finally offering co-pay saver cards for strips....and how about meters now less than $20? My clinic does not give out free meters. I simply don't have the storage, as well as some patients let troubleshooting go out the window looking for a meter replacement when batteries are the issue. I keep a variety of free meter coupons for patients to take to their Doctor for scripts. Recently saw the contour USB...great option for my tech savy patients.
  11. Jun 28, 2010

    I try to match the meter first by the patients needs ie: dexterity-size and ease of handling and ease of use of meter and by the insurance as most insurance companies have a preferred meter which means the co-pay is less expensive. For our patients who go to clinics I carry the meters that the clinic prefers and that they supply strips for etc. There are some patients who just want to pick their meter and do not care about cost of strips(not very many though) Medicare has a wide variety that are allowed. I explain to the patient about durable medical supplies and how it works to order supplies through a durable medical supply company for lower cost. I have tried to learn as much as possible about supplies so I can assist my patients with informed decisions.
  12. Jun 28, 2010

    I don't don't need to help a pt choose a meter as we only have one in the formulary for the military clinic where I work. I generally feel most are comparable however. P personally have used about a dozen myself over the years. I do mention the alternate side testing feature and considerations/limitations, but few seem to take much interest in using that. I did have one pt with Raynauds and when she was having a "flare-up". had to use alternate site as she would only get watery serous blood from her fingers, and that wouldn't give a result.

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