The happy balance between blood sugar control and diabetes cost saving
An article by Deborah Mitchell published in diabetes care, summarizes a study that suggests that many people with Type II Diabetes mellitus can stop home glucose monitoring and can eliminate the pain and stress for millions in both type I and type II as well as the costs (Finger stick several times a day).
This conclusion comes from a team of researchers from Queen Mary University of London. The study conclusion is very interesting and purely monetary. It does not take into consideration the potential cardiac complications that can result from long term poorly controlled blood sugars.
Diabetes is no longer consider just a risk factor for cardiac disease it is considered "cardiac equivalent ", meaning that diabetic patients are to be treated as if they already have heart disease.
Regardless of all the education that patients are given there has to be an alternative way to test the patient in order to document diabetic control . The test is called Hemoglobin A1C(HGB A1C ) . It is usually checked every three months and correlates well with pre meal blood sugar testing.
Blood Sugar HGBA!C
If blood sugar is consistently in the 300 range and the HMG A1c is 12 or above then intervention is needed, to find out the reason for blood sugar elevation, be it infection poor dietary habits obesity lack of exercise, poor compliance or a combination of the above.
Cost savings in one area. (Decrease cost of testing & equipment) may end up being offset by increased admission for diabetic complications such as diabetic ketoacidosis, myocardial infarction and other diabetic complications.
There are other ways to test home blood sugars by using less painful methods such as using alternative sites, rotating sites, or even perhaps testing once a day.
Home glucose monitoring along with diabetic education allows for a partnership between the patient and his doctor and consequently better diabetic control in my opinion . I encourage all my diabetic patient to test their sugars at home , at least once a day at different times of the day sometimes pre-meal or after meal . You
In conclusion, we find ourselves at a crossroad, having to find a happy balance between cost savings and diabetic control and patient compliance and risk factor reduction.