Blood Glucose Test Strips Research Articles

Association of a Blood Glucose Test Strip Quantity-Limit Policy With Patient Outcomes

ImportanceGiven their high costs, payers have considered implementing quantity limits for reimbursement of blood glucose test strips. The effect of these limits on patient outcomes is unknown.ObjectiveTo determine whether the introduction of quantity limits for blood glucose test strips in August 2013 was associated with changes in clinical outcomes.Design, Setting, and ParticipantsCross-sectional time series analysis from April 2008 to March 2015 of residents of Ontario, Canada, aged 19 years and older with diabetes who were eligible for public drug coverage. In a sensitivity analysis, we studied high-volume users of test strips, who were most likely to be affected by the quantity limits.ExposuresEligible patients were stratified into 4 mutually exclusive groups based on diabetes therapy: insulin, hypoglycemia-inducing oral diabetes agents, nonhypoglycemia-inducing oral diabetes agents, and no drug therapy.Main Outcomes and MeasuresThe primary outcome was emergency department visits for hypoglycemia or hyperglycemia, and the secondary outcome was mean hemoglobin A1c (HbA1c) levels. Outcomes were measured for all patients in each quarter, stratified by age group (<65 vs ≥65 years) and diabetes therapy.ResultsBy the end of the study period, 834 309 people met inclusion criteria. Among those younger than 65 years, the rate of hypoglycemia and hyperglycemia declined over the study period (from 4.9 to 3.0 visits per 1000 Ontario drug benefit [ODB]-eligible patients and from 4.2 to 3.6 visits per 1000 ODB-eligible patients, respectively) and was not significantly associated with the introduction of quantity limits (P = .67 and P = .37, respectively). Similarly, among those aged 65 years and older, rates of hypoglycemia and hyperglycemia declined over the study period (from 2.9 to 1.3 visits per 1000 eligible patients and from 0.8 to 0.5 visits per 1000 eligible patients, respectively) and was not significantly associated with the introduction of quantity limits (P = .12 and P = .24, respectively). Results were consistent for the secondary outcome of mean HbA1c levels and in the sensitivity analysis of high-volume test strip users.Conclusions and RelevanceThe imposition of quantity limits for blood glucose test strips was not associated with worsening short-term outcomes, suggesting that these policies can reduce costs associated with test strips without causing patient harm.

Efectividad e impacto económico de un programa de atención integrada con soporte de telemedicina a pacientes diabéticos tipo 2 tratados con insulina (estudio GITDIABE)

AimTo evaluate if insulin-treated type 2 diabetic patients with blood glucose self-monitoring (DIA), included in a program of integrated management of diabetes mellitus (DM), achieve a better level of metabolic control with telemedicine support than with conventional support, after 12 months follow-up. The impact on the use and cost of healthcare services, pharmaceutical expenditure, and consumption of test strips for blood glucose, was also assessed. DesignA prospective parallel cohorts study. FieldFour basic health areas of an integrated healthcare organisation. ParticipantsThe study included 126 DIA patients aged 15 or more years, treated with rapid or intermediate Insulin and blood glucose self-monitoring, grouped into 42 cases and 84 controls, matched according to age, sex, level of metabolic control, and morbidity profile. InterventionTelematics physician-patient communication and download of blood glucose self-monitoring data through the Emminens eConecta® platform; test strips home delivered according to consumption. Hidden controls with usual follow-up. Main measurementsGlycosylated haemoglobin (%HbA1c); perception of quality of life (EuroQol-5 and EsDQOL); cardiovascular risk; use of healthcare resources; consumption of test strips; pharmaceutical and healthcare expenditure. ResultsReduction of 0.38% in HbA1c in the cases (95% CI:−0.89% to 0.12%). No significant differences with regard to any of the activities registered, or any significant change in the quality of life. ConclusionsThe results obtained are similar to other equivalent studies. The profile of the patient is elderly and with multiple morbidities, who still have technological limitations. To surpass these barriers, it would be necessary to devote more time to the training and to the resolution of possible technological problems.

Self-Monitoring of Blood Glucose Levels: Evaluating the Impact of a Policy of Quantity Limits on Test-Strip Use and Costs.

To evaluate the impact of new quantity limits for blood glucose test strips (BGTS) in August 2013 on utilization patterns and costs in the elderly population of Ontario, Canada. We conducted a population-based, cross-sectional time series analysis of all individuals 65 years of age and older who received publically funded BGTSs between August 1, 2010, and July 31, 2015, in Ontario, Canada. The number of BGTSs dispensed and the associated costs were measured for 4 diabetes therapy subgroups-insulin, hypoglycemia-inducing oral agents, non-hypoglycemia-inducing oral agents, and no drug therapy-each month during the study period. We used interventional autoregressive integrated moving average (ARIMA) models to assess the impact of Ontario's policy change on test strip use and costs. In the course of the study period, 657,338,177 test strips were dispensed to elderly patients in Ontario, at a total cost of CAN$482.3 million. Introduction of quantity limits was associated with significant reductions in the number of monthly strips dispensed and the associated costs (p<0.0001). In the year following the policy's implementation, test strip use decreased by 22.2% compared with the prior year (from 145,232,024 test strips to 113,007,795 test strips, a net decrease of 32,224,229 strips), resulting in a 22.5% reduction in costs (from $106.5 million to $82.6 million, a net cost reduction of approximately $24 million). The introduction of quantity limits, aligned with guidance from the Canadian Diabetes Association, led to immediate significant reductions in BGTS dispensing and costs. More research is needed to assess the impact of this policy on patient outcomes.

Differences in self-monitored, blood glucose test strip utilization by therapy for type 2 diabetes mellitus.

AimsTo determine whether blood glucose test strip (BGTS) utilization in patients with type 2 diabetes (T2D) is associated with the type of diabetes therapy, classified according to hypoglycemic risk.MethodsA retrospective, longitudinal (2006–2012) study of Canadian private drug plans (PDP) and Ontario Public Drug Programs (OPDP) prescription claims was conducted. Analyses were restricted to patients with T2D with or without a claim for BGTS. Daily BGTS utilization (TS/patient/day) was evaluated by diabetes therapy classified by hypoglycemic risk. Multivariate analyses were conducted to identify determinants of BGTS utilization.ResultsThe T2D cohort comprised 5,759,591 observations from 1,949,129 claimants. Mean BGTS utilization was 0.84 TS/patient/day and differed between PDP and OPDP (0.66 vs. 1.00). Daily utilization was greatest in patients receiving therapy associated with a pre-defined high risk of hypoglycemia [insulin: basal + bolus (2.16), premixed (1.65), basal (1.16), other insulin regimens (2.13), and sulfonylureas (0.74)] versus non-sulfonylurea non-insulin-based regimens (0.52). For non-insulin therapy, BGTS utilization was greater for patients on multiple non-insulin therapies versus monotherapy (0.74 vs. 0.53 TS/patient/day). In multivariate analyses, drivers for BGTS utilization included insulin use, previous BGTS use, and female gender. Previous diabetes therapy and duration of therapy were negatively correlated with BGTS utilization.ConclusionsBGTS utilization varies depending on the type of therapy used to treat T2D according to hypoglycemic risk. Decision making regarding BGTS needs to account for robust analyses of current utilization and its value in those settings, including in patients not receiving diabetes therapy and the prevalence of circumstances conducive to more intensive monitoring.

Opportunity Cost and Policy: A Utilization Review of Self-monitoring of Blood Glucose in Manitoba, Canada

PurposeRecently, there has been a re-evaluation of the frequency, benefits, and costs associated with self-monitoring of blood glucose (SMBG). Based on little evidence of the benefit of frequent SMBG in patients with diabetes not using insulin, new guidelines and test strip limit policies have been suggested and implemented in various Canadian jurisdictions to promote a more selective practice of SMBG. The objective of this study was to assess the overall utilization and cost associated with test strips and lancets for SMBG in Manitoba from 2000 to 2013 as well as to explore the policy implications of the implementation of test strip quantity limits and its impact on overall and government costs. MethodsAn analysis of prescription claims for blood glucose test strips (BGTSs) and lancets for all patients with diabetes in Manitoba from 2000 to 2013 was conducted. In each year, patients were stratified into 4 mutually exclusive hierarchical groups according to most intensive diabetes treatment. Test strip and lancet utilization and cost were assessed for each group in each year, and the potential cost savings associated with implementation of a BGTS limit policy was projected using autoregressive integrated moving average models. FindingsIn the year 2000, 8 million test strips were dispensed in Manitoba, increasing by 170% to 21.7 million test strips in 2013. Insulin users accounted for the majority of test strip use. However, based on potential implementation of test strip limit policies, 95% of the reduction of test strip use is predicted to occur in the groups not using insulin. Based on current trends, the 5-year predicted additional cost associated with not implementing a test strip limit policy similar to that implemented in other Canadian provinces was estimated to be a total of $12.35 million. ImplicationsImplementation of the guideline-based policy limits is predicted to produce considerable savings, with 95% of potential savings occurring in patients not using insulin. There is, therefore, a significant opportunity cost associated with not implementing a policy to reduce BGTS utilization by patients with diabetes in Manitoba. Based on the lack of evidence to suggest significant outcome improvements with long-term frequent SMBG by patients not using insulin, more selective use of test strips for SMBG could allow for significant cost savings that could be redirected to other programs and interventions for the growing population of patients with diabetes in Manitoba.

The Economic Burden of Post-prandial Hyperglycemia (PPH) Among People with Type 1 and Type 2 Diabetes in Three Countries.

IntroductionPost-prandial hyperglycemia (PPH) among people with diabetes is a well-known clinical challenge to diabetes management. While the economic burden of diabetes is well studied, little is known about economic costs specific to PPH. The purpose of this study was to investigate costs of PPH related to work, diabetes management, and use of healthcare resources among people with diabetes taking bolus insulin.MethodsData were collected in a web survey of 906 adults with type 1 (39%) and type 2 (61%) diabetes taking bolus insulin in Germany (34%), the UK (26%), and the USA (40%).ResultsSixty-two percent of respondents experienced PPH in the past week, and respondents averaged 1.7 episodes per week. Working respondents indicated that PPH affected their work productivity: 27% missed work time and 71% experienced work productivity issues while at work due to a recent episode of PPH. In terms of diabetes management, respondents with PPH in the past week measured their blood glucose (BG) more frequently than those without PPH (3.7 vs. 2.5 times/day, P < 0.001). PPH was also significantly associated with greater use of healthcare resources. Compared to those without PPH, respondents with PPH reported greater contact with healthcare professionals related to diabetes in the past year (5.5 vs. 4.4 visits, P < 0.001; 2.7 vs. 1.4 calls/emails, P < 0.001) and were more likely to report medical complications related to diabetes (72% vs. 55%, P < 0.001). Average annual costs associated with PPH due to missed work time, additional BG test strips, and physician visits were estimated to be $1239 USD per employed person in the USA.ConclusionResults indicate that PPH is associated with greater economic costs and that reducing the incidence of PPH would help mitigate such costs. Additional research is needed to better understand costs associated with PPH that may be more difficult to measure, as well as more long-term impacts and costs.FundingNovo Nordisk.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-016-0154-2) contains supplementary material, which is available to authorized users.

Correct storage of blood glucose test strips

Correct storage of blood glucose test strips

Evaluating the Cost of Bringing People with Type 2 Diabetes Mellitus to Multiple Targets of Treatment in Canada

PurposeEvidence suggests that clinical outcomes for people with type 2 diabetes mellitus can be improved through multifactorial treatment. The key challenges in the successful treatment of type 2 diabetes include maintaining tight glycemic control, minimizing the risk of hypoglycemia, controlling cardiovascular risk factors, and reducing or controlling weight. The aim of the present analysis was to evaluate the cost per patient achieving a composite clinical end point (glycosylated hemoglobin <7%, with no weight gain and no hypoglycemic events) in patients with type 2 diabetes in Quebec, Quebec, Canada, receiving liraglutide 1.2 mg, liraglutide 1.8 mg, thiazolidinedione, sulfonylurea, insulin glargine, sitagliptin, or exenatide. MethodsThe proportion of patients achieving control was taken from a meta-analysis that was based on the Phase III trial program of liraglutide. Treatment costs, estimated from a health care payer perspective, were calculated on the basis of the trials included in the meta-analysis and captured the study drug, needles, self-monitoring of blood glucose (SMBG) test strips, SMBG lancets, and other antidiabetes medications received. Cost-effectiveness in terms of cost per patient achieving the composite end point (cost of control) was evaluated with an economic model developed in Microsoft Excel. No discounting was applied to cost or clinical outcomes because these were not projected beyond a 1-year time horizon. Sensitivity analyses were performed. FindingsLiraglutide 1.8 mg was associated with the lowest number needed to treat, with 3 patients needing to be treated to bring 1 patient to the composite end point. Pioglitazone was associated with the highest number needed to treat, with 17 patients requiring treatment to bring 1 patient to the composite end point. Evaluation of only annual pharmacy costs indicated that liraglutide 1.8 mg was the most costly treatment at Can$2780 per patient per year. Pioglitazone and glimepiride were associated with the lowest direct annual costs. Combining the clinical efficacy data with the annual cost of medications produced cost of control values of Can$6070 (liraglutide 1.2 mg), Can$6949 (liraglutide 1.8 mg), Can$7237 (glimepiride), Can$7704 (exenatide), Can$8297 (insulin glargine), Can$8741 (pioglitazone), and Can$9270 (sitagliptin) per patient achieving the composite end point. ImplicationsLiraglutide 1.2 mg and 1.8 mg were associated with the lowest cost of control values, driven by the high proportion of patients achieving the composite end point, which offset the higher medication costs. A relatively low cost of control value was achieved for glimepiride, driven by low acquisition costs, despite relatively few patients achieving the composite end point.

A wireless potentiostat for mobile chemical sensing and biosensing

Wireless chemical sensors are used as analytical devices in homeland defence, home-based healthcare, food logistics and more generally for the Sensor Internet of Things (SIoT). Presented here is a battery-powered and highly portable credit-card size potentiostat that is suitable for performing mobile and wearable amperometric electrochemical measurements with seamless wireless data transfer to mobile computing devices. The mobile electrochemical analytical system has been evaluated in the laboratory with a model redox system – the reduction of hexacyanoferrate(III) – and also with commercially available enzymatic blood-glucose test-strips. The potentiostat communicates wirelessly with mobile devices such as tablets or Smartphones by near-field communication (NFC) or with personal computers by radio-frequency identification (RFID), and thus provides a solution to the ‘missing link’ in connectivity that often exists between low-cost mobile and wearable chemical sensors and ubiquitous mobile computing products. The mobile potentiostat has been evaluated in the laboratory with a set of proof-of-concept experiments, and its analytical performance compared with a commercial laboratory potentiostat (R2=0.9999). These first experimental results demonstrate the functionality of the wireless potentiostat and suggest that the device could be suitable for wearable and point-of-sample analytical measurements. We conclude that the wireless potentiostat could contribute significantly to the advancement of mobile chemical sensor research and adoption, in particular for wearable sensors in healthcare and sport physiology, for wound monitoring and in mobile point-of-sample diagnostics as well as more generally as a part of the Sensor Internet of Things.

The impact of policies to reduce blood glucose test strip utilization and costs in Canada.

Several strategies have been proposed to manage the utilization of blood glucose test strips (BGTS) in Canada; however their potential impacts on utilization and costs of publically funded test strips are unknown. We investigated the impact of three potential policies that would restrict the number of test strips reimbursed by the public drug plans in Ontario and British Columbia (BC), and incorporated negotiated price reductions. These policies were based on recommendations from the Canadian Agency for Drugs and Technologies in Health, a briefing document by the Canadian Diabetes Association, and a new policy introduced by the Ontario Ministry of Health and Long-Term Care. BGTS utilization rates were assessed in two cross-sectional analyses among adults aged 18 years or older in BC and 65 or older in Ontario who received publicly-funded BGTS between January 2004 and December 2012. We modeled the 5-year utilization and cost implications of the three policies using time-series analysis. In 2012, there were 317,130 test strip recipients in Ontario and 136,659 recipients in BC, at a cost of $104.4 million and $22.6 million respectively. Under the scenarios of reduced BGTS quantities, 5-year cost savings ranged between $98.8 million (18.2% reduction) and $224.1 million (41.4% reduction) in Ontario and between $23.1 million (19.2% reduction) and $51.1 million (42.4% reduction) in BC. Price reductions of 15% resulted in annual savings of $14.4 million (13.7% reduction) in Ontario and $3.4 million (14.1% reduction) in BC. Policies that align with evidence and expert guidance could impart substantial cost savings in multiple jurisdictions despite different public drug plans.

PDB59 - Evaluating the Cost of Bringing People with type 2 Diabetes mellitus to multiple targets of Treatment In Canada

Abstract Purpose Evidence suggests that clinical outcomes for people with type 2 diabetes mellitus can be improved through multifactorial treatment. The key challenges in the successful treatment of type 2 diabetes include maintaining tight glycemic control, minimizing the risk of hypoglycemia, controlling cardiovascular risk factors, and reducing or controlling weight. The aim of the present analysis was to evaluate the cost per patient achieving a composite clinical end point (glycosylated hemoglobin Methods The proportion of patients achieving control was taken from a meta-analysis that was based on the Phase III trial program of liraglutide. Treatment costs, estimated from a health care payer perspective, were calculated on the basis of the trials included in the meta-analysis and captured the study drug, needles, self-monitoring of blood glucose (SMBG) test strips, SMBG lancets, and other antidiabetes medications received. Cost-effectiveness in terms of cost per patient achieving the composite end point (cost of control) was evaluated with an economic model developed in Microsoft Excel. No discounting was applied to cost or clinical outcomes because these were not projected beyond a 1-year time horizon. Sensitivity analyses were performed. Findings Liraglutide 1.8 mg was associated with the lowest number needed to treat, with 3 patients needing to be treated to bring 1 patient to the composite end point. Pioglitazone was associated with the highest number needed to treat, with 17 patients requiring treatment to bring 1 patient to the composite end point. Evaluation of only annual pharmacy costs indicated that liraglutide 1.8 mg was the most costly treatment at Can$2780 per patient per year. Pioglitazone and glimepiride were associated with the lowest direct annual costs. Combining the clinical efficacy data with the annual cost of medications produced cost of control values of Can$6070 (liraglutide 1.2 mg), Can$6949 (liraglutide 1.8 mg), Can$7237 (glimepiride), Can$7704 (exenatide), Can$8297 (insulin glargine), Can$8741 (pioglitazone), and Can$9270 (sitagliptin) per patient achieving the composite end point. Implications Liraglutide 1.2 mg and 1.8 mg were associated with the lowest cost of control values, driven by the high proportion of patients achieving the composite end point, which offset the higher medication costs. A relatively low cost of control value was achieved for glimepiride, driven by low acquisition costs, despite relatively few patients achieving the composite end point.

Hunger state affects both olfactory abilities and gustatory sensitivity.

Chemical senses such as odor, taste and appearance are directly related with appetite. Understanding the relation between appetite and flavor is getting more important due to increasing number of obese patients worldwide. The literature on the studies investigating the change in olfactory abilities and gustatory sensitivity mostly performed using food-related odors and tastes rather than standardized tests were developed to study olfaction and gustation. Therefore, results are inconsistent and the relationship between olfactory and gustatory sensitivity with respect to the actual state of human satiety is still not completely understood. Here, for the first time in literature, we investigated the change in both olfactory abilities and gustatory sensitivity in hunger and in satiety using 123 subjects (37 men, 86 women; mean age 31.4years, age range 21-41years). The standardized Sniffin' Sticks Extended Test and Taste Strips were used for olfactory testing and gustatory sensitivity, respectively. TDI score (range 1-48) was calculated as the collective scores of odor threshold (T), odor discrimination (D) and odor identification (I). The evaluation was performed in two successive days where the hunger state of test subjects was confirmed by blood glucose test strips (mean blood glucose level 90.0±5.6mg/dl in hunger and 131.4±8.1mg/dl in satiety). The results indicated statistically significant decrease in olfaction in satiety compared to hunger (mean TDI 39.3±1.1 in hunger, 37.4±1.1 in satiety, p<0.001). The comparison of gustatory sensitivity indicated significantly higher sensitivity to sweet, sour and salty in hunger (p<0.001), but significantly higher sensitivity to bitter tastant in satiety (p<0.001). With this prospective study, we were able to show that both olfactory abilities and gustatory sensitivity were affected by hunger state.

Origin of Low Detection Limit and High Selectivity of Roche Accu‐Chek Test Strips that Enables Measurement of Tear Glucose Levels

AbstractTear glucose measurements have been suggested as a potential alternative to blood glucose monitoring for diabetic patients. While previous work has reported a correlation between blood and tear glucose levels in humans, this link has not been thoroughly established and additional clinical studies are needed. We recently reported that Roche’s electrochemical Accu‐Chek blood glucose test strips exhibit far superior analytical performance over other commercial brands, with the low detection limit and high selectivity required for quantitating tear glucose levels. Herein, we evaluate the origin of the high sensitivity and selectivity of the Roche test strips and show that the use of pyrroloquinoline quinone (PQQ)‐dependent glucose dehydrogenase (GDH) as an active enzyme reagent in combination with a nitrosoaniline derivative as an electron transfer mediator are primarily responsible for the low limit of quantification (LOQ) (ca. 9 µM) and enhanced selectivity achieved with these strips.

Urgent Reimbursement Need for Diabetes Supplies in Blood Glucose Management of Diabetic Patients

To achieve long-term diabetic complication reduction and decrease the health care costs, all diabetic patients must have access to the components of diabetes care modality, such as medications, supplies, and self-management education programs. However, our current government policies for diabetic patients are not sufficient to allow for adequate blood glucose control. Our national insurer does not reimburse for diabetes supplies such as blood glucose testing monitors, blood glucose test strips, lancet devices and lancets, insulin syringes and pen needles, and alcohol swabs. The government officer states that national laws, regulations, executive order, and financial problems prohibit the reimbursement of diabetes supplies. However, to achieve good outcomes and decrease the public burden of medical care costs, all stake holders, health care professionals, and diabetic patients should exert effort to require reimbursement of diabetic supplies.

Prevalence and Associated Factors of Diabetes Mellitus in Benin

Background: Data on diabetes mellitus in general population in Benin is scarce. This study aimed therefore to assess prevalence and risk factors of diabetes mellitus in Benin. Methods: The study consisted of a cross-sectional survey, using the World Health Organisation (WHO)’s instrument for stepwise surveillance (STEPS) of non-communicable diseases risk factors. A five-stage random sample of 25 to 64 years old male and female adults living in Benin participated in structured interviews and their size, weight and blood pressure were measured according to standardized procedures. Glycaemia was measured using ACCUTREND? test strips for capillary blood glucose. Prevalence and means were computed with their 95% confidence interval and standard error respectively, taking into account the sampling design. Prevalence was compared by Khi2 and means by Student’s t test. Univariate and multivariate logistic regressions were performed to identify socio-demographic diabetes’s risk factors. Results: A total of 3772 adults participated in the study. The average age of respondents was 44.2 years. Overall, 68.3% of subjects were illiterate, 82.4% lived in rural areas, 82.57% were self-employed, 20% overweight, 7.51% obese and the prevalence of hypertension was 29.5 p.100. The prevalence of diabetes mellitus was 1.4 p.100 [CI95% = (0.94:2.05)]. This prevalence was higher in men than in women (2.1% vs. 0.8%, p = 0.0031). This prevalence was higher in urban areas than in rural areas. The Littoral department had the highest prevalence (3.4%), followed by the Collines department (2.7%), Donga (2.4%) and Borgou (2.3%). As many as 49.3% of subjects diagnosed with diabetes mellitus were not aware of their status. The age group of 56 - 64 years had the highest risk [OR = 6.6, IC95% = (1.6; 22.4)]. The risk of diabetes was higher in people living in urban areas than in people living in rural areas [OR = 3.04 CI95% = (1.6; 6.0)]. After controlling for confounding factors, risk factors of diabetes were gender, men being more at risk than women (p = 0.002) age from 55 to 64 years (p = 0.009), overweight (p < 0.0001) and obesity (p = 0.002). Conclusion: Our findings suggested that diabetes mellitus was common in Benin. The prevalence of diabetes is more likely to increase in regard to the nutritional transitions (diet) and the accelerating urbanization of Benin. Communication campaigns for behavioral change are needed to slow down or even reverse this trend.

Anti-Diabetic Assessment of the Hydro-Alcoholic Leaf Extracts of the Plant Tetrastigma angustifolia (Roxb.)a traditionally used North-Eastern Indian vegetable

Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycaemia generally associated with oxidative stress. The present study aims to evaluate the hypoglycaemic activity of hydro-ethanolic (3:7) leaf extracts of Tetrastigma angustifolia (Roxb.) (Family: Vitaceae) to streptozotocin induced diabetic wistar albino rats. The blood glucose level was measured using single touch blood glucose test strips and glucometer on weekly intervals until the end of 21st day. Other blood parameters like total lipid and liver profiles were investigated after oral administration of extracts to diabetic rats after the treatment of three weeks. The Histopathological changes of the diabetic and vehicle control rats were also investigated in this study. Daily oral administration of hydro-alcoholic leaf extracts (HSE 250 mg/kg & 500 mg/kg body weight) and metformin hydrochloride (5 mg/kg body weight) showed improvement effect on blood glucose level as well as hyperlipidaemia and liver functions due to streptozotocin induced diabetes (Type II). The extract has beneficial effects to maintain the animal body weight and has the regenerating power to pancreatic cells. The hydro-alcoholic leaf extracts dose fractions of Tetrastigma angustifolia (Roxb.) exhibited significant anti-hyperglycemic activities. The extract showed improvement in parameters like body weight and lipid profiles as well as regeneration of â-cells of pancreas and so might be of value for the treatment of diabetes (Type- II).

Use of an Insulin Bolus Advisor Facilitates Earlier and More Frequent Changes in Insulin Therapy Parameters in Suboptimally Controlled Patients with Diabetes Treated with Multiple Daily Insulin Injection Therapy: Results of the ABACUS Trial

We assessed the impact of using an automated bolus advisor integrated into a blood glucose meter on the timing and frequency of adjusting insulin therapy parameter settings and whether the availability of this technology would increase blood glucose test strip utilization in diabetes patients treated with multiple daily insulin injection (MDI) therapy. The Automated Bolus Advisor Control and Usability Study (ABACUS) trial, a 26-week, prospective, randomized, controlled, multinational study that enrolled 218 type 1 and type 2 diabetes patients, demonstrated that use of an automated insulin bolus advisor helps improve glycemic control in suboptimally controlled, MDI-treated patients. Patient data were assessed to determine when and how often changes in insulin parameter settings occurred during the study. Patient meters were downloaded to determine blood glucose monitoring frequency. One hundred ninety-three patients completed the study: 93 control arm (CNL) and 100 intervention (experimental) arm (EXP). Significantly more EXP (47.5%) than CNL (30.7%) patients received one or more changes in their insulin sensitivity factor (ISF) settings during the study (P=0.0191). Changes in ISF settings occurred earlier and more frequently in EXP than CNL patients throughout the study. A similar trend was seen in changes in insulin-to-carbohydrate ratios. There were no differences in daily self-monitoring of blood glucose frequency [mean (SD)] between CNL and EXP patients: 4.7 (1.5) versus 4.6 (1.3) (P=0.4085). Use of an automated bolus advisor was associated with earlier, more frequent changes in key insulin parameters, which may have contributed to subsequent improvements in glycemic control but without increased glucose test strip utilization.

Antidiabetic, hypolipidemic and histopathological analysis of Gymnema sylvestre (R. Br) leaves extract on streptozotocin induced diabetic rats

ObjectiveTo investigate antidiabetic, hypolipidemic histopathological analysis of Gymnema sylvestre methanolic extract (GSME) in streptozotocin induced diabetic rat by administering oral doses (100, 200 and 400mg/kg body weight). MethodsBlood glucose levels were measured using blood glucose test strips with elegance glucometer on weekly intervals till the end of study (i.e. four weeks). Blood glucose, urine sugar, triglycerides (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) and very low density lipoprotein (VLDL) were determined in normal and streptozotocin induced diabetic rats after oral administration of the extract for 28 days. Histopathological changes in diabetic rat organs (pancreas, liver, and kidney) were also observed after extract treatment. ResultsDaily oral administration GSME (100, 200 and 400mg/kg body weight) and glibenclamide (5mg/kg) showed beneficial effects on blood glucose level (P<0.01) and hyperlipidaemia due to diabetes. The extract treatment also showed to enhance serum insulin level and body weight of diabetic rats as compared to diabetic control group. Furthermore, the extract has a favorable effect on the histopathological studies, in streptozotocin induced diabetes. ConclusionsG. sylvestre possesses antidiabetic property as well improve body weight, and total lipid levels. GSME has also favorable effect to inhibit the histopathological changes in streptozotocin-induced diabetes.

Electrochemical Sensors for Measurement of Glucose in Tiny Volumes of Tear Fluid

Tear glucose measurements have been suggested as a potential non-invasive alternative to blood glucose monitoring for diabetic patients [1,2]. While previous work has demonstrated a correlation between blood and tear glucose values in humans using complex LC-MS and capillary electrophoresis methods, this correlation has not been thoroughly established and additional clinical studies with a much larger patient population are sorely needed. This requires the availability of a very simple device that can quantitate the levels of glucose in tiny volumes (1 uL or less) of human tear fluid at the point of testing. Further, given the low levels of glucose found in tear fluid (10-300 µM), compared to blood plasma (3-15 mM), this creates a challenge for the conventional electrochemical measurement technologies typically employed for blood glucose measurements. In preliminary efforts toward achieving this goal, we utilized miniaturized needle type amperometric glucose enzyme electrodes that can be inserted into a microliter glass capillary tube to measure the levels of glucose in tear fluid obtained from anesthetized rabbits and proved that there was a reasonable correlation between blood and tear glucose levels [3,4]. However, the sensors employed in these first studies required 3 µL or more of tear fluid and the capillary tube was used to conveniently sample such volumes. A more attractive approach for determining glucose in < 1 µL tear volumes from human subjects is to use commercial electrochemical blood glucometer test strips in association with a laboratory quality, high current sensitivity potentiostat. Of many commercial blood glucose test strips evaluated, only one device has been found to be capable of achieving the low detection limits (< 10 µM) required for human tear glucose measurements. Using such strips, calibration data in the range of 0-300 μM glucose yield excellent precision and good selectivity over potential redox species found in tears (e.g., ascorbic and uric acids). Multiple measurements of glucose in tear fluid obtained from normal (non-diabetic) human subjects using commercial strips in conjunction with a laboratory potentiostat yield fasting tear glucose concentrations for non-diabetics within the range of 20-160 µM, similar to the values found by others using more complex LC-MS methods [1]. This glucometer strip based method could greatly facilitate more in depth clinical studies with a large number of patients (both normal and diabetic), to determine definitively whether tear glucose and blood glucose levels correlate well enough to enable routine measurements in tear fluid to supplement blood glucose testing.

Frequency of blood glucose testing among insulin-treated diabetes mellitus patients in the United Kingdom

Background:Through a retrospective database analysis, this study seeks to provide an understanding of the utilization of SMBG by insulin therapy and diabetes type and to estimate healthcare costs of blood glucose monitoring in the UK diabetes population.Methods:Data were obtained from the IMS LifeLink Electronic Medical Record-Europe (EMR-EU) Database, a longitudinal database containing anonymized patient records from physician–practice data systems of office-based physicians in the UK. Depending on the insulin types used for type 1 and type 2 diabetes, patients were sub-categorized into one of four insulin regimen groups (basal, bolus, pre-mixed, or basal-bolus). Frequency of blood glucose testing was assessed descriptively throughout the 12-month post-index period, and generalized linear models were used to evaluate the effect of baseline characteristics, including insulin type, on the likelihood of blood glucose test utilization. Healthcare resource utilization and costs for all-cause services were assessed by insulin type.Results:This study identified 8322 type 1 and type 2 diabetes patients with two insulin pharmacy records between January 1, 2009 and December 31, 2010. After applying study inclusion and exclusion criteria, a total of 2676 (32.2%) insulin-treated diabetes mellitus patients in the UK were identified, with the number of pharmacy blood glucose test strips averaging 771.1 (median 600). The glucose testing frequency was lowest among basal-only insulin patients and pre-mixed insulin patients (mean = 576.2 [median = 450] and mean = 599.5 [median = 500], respectively; non-significantly different) compared to other insulin types.Conclusion:Although the data did not capture the glucose frequency comprehensively, it varied significantly by insulin types, and was higher than what is recommended in the guidelines for patients with type 2 diabetes.