The first FDA cleared and CE certified Bluetooth ® blood glucose meter recently was announced and launched in the U.S. by Entra Health Systems. The MyGlucoHealth meter and MyGlucoHealth Network form an “integrated telemedicine platform”. It’s a great start to bringing our many meters, log books, and other forms of data into the same place and saved for patients and healthcare professionals to review.
The meter works in combination
with a real-time online data collection network to upload and manage readings
using a mobile phone or computer. Patients can securely transmit and evaluate
readings while communicating results to families or physicians.
Test results can be seen in three seconds and has a blood sample size of 0.3 microliters. This compares to most other meters that have ~ five seconds and 0.03 microliters Test strips are automatically coded, which is a big advantage. All in all, this sounds pretty competitive – we don’t know what kind of strips it uses or if these will be covered by insurers, which is always a big question. The technology can monitor the testing results and also the patterns of the testing. The company points out that the network can set up reminders to test more frequently and even notify the patient’s family or caregivers when results exceed certain thresholds or fluctuate.
We’re happy to see a Bluetooth-enabled device finally hitting the market and potentially eliminating the need for the box of cables and mismatched meters. However, we wonder how many people with diabetes would feel like a wireless leash was attached to their meter if their family and caregivers were immediately seeing each and every reading at all times – it will be interesting to test reactions!
Older adults with type 2 diabetes have increased risk of dementia after one single episode with a low blood sugar sending them to the emergency room. A new study published recently in JAMA found that one episode of severe hypoglycemia increased risk of dementia at a later age by 45%. Two episodes increased the risk by 115% and three or more episodes raised the risk by 160%.
The 16,667 patients who were in the Kaiser Permanente system had a mean age in the mid-60s. Their records were analyzed for trips to the hospital or emergency room for hypoglycemia from 1980 through 2002 and then followed from 2003 to 2007 for signs of dementia.
Approximately 9% of the patients had serious episodes of hypoglycemia in the 22-year period and 11% were diagnosed with dementia between 2003 and 2007. Study author Rachel Whitmer, a research scientist with Kaiser Permanente, emphasized the study’s results and correlation to the importance of blood glucose control.
"Overall, I’m very optimistic about the SEVEN PLUS. I think that however much I loved the SEVEN, the SEVEN PLUS really represents a great improvement over the first-generation SEVEN, and both the trend arrows and the rate of change information in particular are big steps. I’ve found that the trend arrows really help me to improve my management—I got really good at not checking my blood glucose after eating cake, and then I got good at not looking at my CGM for 9 hours, but it’s awfully hard to ignore two arrows straight up (as long as you’re looking at your CGM) for 24 hours!"
Recent studies report an increased obesity rate among teens at schools where fast-foot restaurants were less than a tenth of a mile (one city block) away. It’s not a small chance, either – the increased risk is 5.2 percent. A city councilman from Queens proposed a ban on building/placing new fast-food restaurants within one tenth of a mile of a school. That sounds GREAT to us. Ironically, councilman Goia presented the proposal at a school opposite a McDonald’s. Immediate proximity is cited by researchers to directly impact the rate of childhood obesity. However, a location .25 and .5 miles away from a school did not impact the rates.
The study itself culled data from eight years of 1,047 California high schools, finding that caloric intake would increase 30 to 100 calories per day depending on the proximity of a restaurant. Students who were Hispanic and female had the greatest impact. Pregnant women were also studied and found to gain more weight if a fast-food outlet was within a tenth of a mile of their home.
The study, which was published in February 2009 culled data over eight years from 1,047 California high schools. It found that caloric intake could increase 30 to 100 calories a day depending on the proximity of a fast-food restaurant and that the effect was greatest for students who were Hispanic and female.
And good news, Mr. Gioia is clearly on the money and thinking really broadly and thoughtfully about this – he does not recommend the proposal as the only measure. Instead, he suggests it should be accompanied by other tactics like placing green markets in poorer neighborhoods and including education about healthy eating. He mentioned that the neighborhoods with the highest obesity rates were those that had 28 fast-food restaurants within a tenth of a mile of a school.
“If we’re not willing to move harmful substances away just one block, what are we willing to do?” he asked.
Let’s get more discussions like this going – and also try to get good information to fast food outlets so they have healthier choices that are cheaper and more likely to sell. As we understand it, McDonald’s is one of the largest buyers of fresh apples in the world, as of 2005 – that is a major change from some years back and great to see.
Report cards are adding a new dimension this fall in Massachusetts when public schools will begin sending reports home to parents. The reports will include alerts of too much or too little weight on their children, a main component of a campaign to combat childhood obesity.
Modeled after initiatives in Arkansas and New York City (the usual front-runners of setting trends in combating obesity), the screenings won unanimous approval earlier this month from the Massachusetts Public Health Council, which consists of an appointed board of doctors, academics, and service providers. It will be phased in over the next two school years and will be more than a standard report, providing recommendations and suggestions for parents. This is excellent – a very comprehensive strategy composed of more than just information, which was a problem with earlier attempts to heighten parent awareness of problems.
More than 286,000 students will undergo initial evaluation before the end of the 2010-2011 school year. Students in the first, fourth, seventh, and 10th grades will be measured and weighed to calculate the students’ BMI.
Most health professionals and medical associations were entirely supportive of the initiative, but others had their doubts, discussing the cost of another unfunded mandate and the line parents would walk between encouraging healthy eating and perhaps focusing too much on weight loss strategies. While we hope there will be a responsible balance, of course, the threat of obesity weighs so heavily that we wouldn’t like to think that too much focus on weight loss strategies is really a threat. (Clearly, this assumes those who are at normal weight would be counseled on healthy eating and exercise, but not on losing weight.)
Massachusett’s public health commissioner, John Auerbach, said he believes the financial cost to school districts will be nominal, in part because many were already weighing and measuring students annually.
"Right now, in many situations, the data from height and weight measurements sit in a file, and even if it's concerning, the parent may not find out," Auerbach said.
"This helps us make sure the most important person in that child's life finds out." Here, here …thank you Massachusetts, and bring this on in California and across the rest of the country!
Health care costs are higher for you and your insurance company if you engage in risky behavior– and they now have the proof to back this up. A study in the June 2009 issue of the American Journal of Preventative Medicine of more than 43,000 members of the Arkansas State and Public School Employees Health Plan found that health care costs are higher for those who report they are obese, are smokers or are physically inactive
Lead author Rhonda Hill, a prevention specialist with the Arkansas Center for Health Improvement in Little Rock, acknowledged the results were expected but that they demonstrated personal health habits were a big indicator of costs.
The increase in cost annually was 13 percent higher for smokers, 45 percent higher for those who were obese, and 33 percent higher for the inactive population. The annual increase was 75 percent higher for those who were both obese and inactive. Those who said they had all three risks had 86 percent higher annual costs on average than those with no behavioral risks.
Self-identified participants with high risk had an average annual health care cost of $4,432; those who did not engage in risky health behaviors had an annual average cost of $2,382. Those aged 55 to 64 who engaged in three categories of risky behavior doubled their costs compared to those in the same age group without.
We’d love to see more rewards given to patients who don’t come in with any behavioral risks – think of the incentives and the funds that could be saved if you could partially reward patients and healthcare providers too!
No way! Coca-Cola ran giant ads in local Australian papers saying the soft drink doesn’t contribute to obesity, but the Australian Competition & Consumer Commission took issue and forced them to publish corrective advertisements. The ACCC said the ads had the potential to mislead parents about the “potential consequences” of consuming Coke and that the messages were “totally unacceptable”, creating a misleading impression that the soda beverage would not contribute to weight gain, obesity, and tooth decay.
In the corrective ads, Coca-Cola doesn’t directly say that their beverage doesn’t contribute but that “no single food or beverage alone is responsible for weight gain.” It also corrected the assertion that a 250 milliliter Diet Coke contains half the amount of caffeine as the same portion of tea; it really contains two-thirds.
We found it ironic that the original ads featured Australian actress Kerry Armstrong and a personal message about being bombarded with conflicting messages about food and drinks; that “one day something is good for you and the next day it’s bad and that can be confusing”. (The actress wasn’t featured in the corrective ads.)
There are two types of health literacy – one where you are able to read written directions and your medicine bottles; the other where you are given directions or explained your condition and you are able to internalize, comprehend, and take action to take care of yourself.
For diabetes, we may all too often jump to the conclusion that health literacy is the first kind; when there are problems, it’s because people can’t read when to take their oral medication or something similar. However, after reading a NYTimes article including a story of a patient with diabetes who ended up dying from complications, we realize there’s a huge barrier to care in comprehension that needs to be fixed in our health care system, too.
Jack, the patient, was a former start athlete who had diabetes, high blood pressure, vascular disease, and kidney failure. He had two leg amputations. Most of the nurses and doctors described him as “out of control” because of potential drug use or refusal to acknowledge his medical conditions. But as the author suggests, it may have been because no one ever explained his condition and the importance of self-care
How often does this occur in real life? More often than we’d like. New studies suggest half of Americans have struggles obtaining, understand, or acting on health information, which researchers now call “limited health literacy”. Being familiar with diabetes, we understand just how important self-care is and how it really makes the difference of living a relatively healthy life and having a story like Jack’s.
But what can we do?
Patients can take a more active role in educating themselves about health. This can be gathering up the courage to ask your busy doctor a question if you’re unsure; calling back to double check directions on your medication; and empowering yourself with more education and information so you understand why self-care is so important. Never be embarrassed if you don’t understand something a doctor is saying – after all, they’ve had years of medical training; they should be able to explain it clearly and in a way that you can understand and act on. Also, we highly recommend asking for a diabetes educator if you don’t have one. As we understand it, only 30% of people with diabetes have educators – you deserve one if you don’t have one! Medicare pays for ten hours of diabetes education the year you are diagnosed and two hours a year thereafter – although we don’t think this is nearly enough, it should be a great start. If you need an educator, call 1-800-832-6874
Doctors and educators can ask a follow up question such as “Did I explain this clearly?” or ask patients to repeat the directions back to demonstrate understanding. Patients, if you feel rush, interrupt your doctor and ask “Oh, can I repeat this back to you to make sure I’ve understood you clearly” so your doctor AND you are clear about their directions. We know doctors are busy and already pressed for time, but catching those red flags of misunderstanding could save a patient’s life, especially for diseases that are so patient-centered like diabetes.
What else can be done to improve health literacy?