Diabetes Update: Another Option

Chronic diseases and conditions comprise the largest of today's home care populations. Diabetes is among the most prevalent of these chronic conditions. The difficulties associated with this disease are extensive, which can take physical, emotional and financial tolls on patients.

The cost of treating diabetes in the United States is approximately $98 billion, according to the American Diabetes Association. Many researchers believe these costs can be reduced if diabetics take regular daily care steps such as blood glucose monitoring and tracking to manage their condition.

Preventive steps can be taken between clinic appointments thanks to new trends and technologies in diabetic health aids. Trends such as foot health care kits have become more popular due to increased coverage and reimbursements by Medicare.

Foot Health

Foot health care is a major factor in the life of a diabetic due to poor circulation. Often, patients develop foot ulcers that cause lower appendage amputation later in life. According to studies, almost half of these amputations can be prevented through conservative protection such as compression socks, shoes and other foot care products.

Many companies, such as Apex Foot Health Industries Inc., South Hackensack, N.J., are taking the foot health care industry into new phases by providing products and corresponding education. Seminars offered by Apex focus on teaching home medical equipment (HME) providers the proper ways to fit diabetic shoes and on the benefits of foot care products for the diabetic patient.

"You don't need extensive medical training, but it is important that the HME provider be knowledgeable about the products and can properly measure and fit them so they will have the best results," says Larry Schwartz, marketing director at Apex.

The company designs free Web sites that can benefit providers by expanding awareness of available products and linking Internet users to online shopping and educational information.

Acor Orthopedic, Cleveland, a manufacturer of custom shoes used primarily by diabetics, believes prevention is an important reason why foot care aids are becoming more and more popular.

"A major problem is that diabetic patients don't know about their Medicare benefits," said Acor's Marketing Director George Trimbole, referring to the Medicare Therapeutic Bill of 1993, which allows for reimbursement on preventive foot care products. "What we try to do is educate HME providers on how to market these products so that patients are aware of them."

Home Monitoring

Foot care is only one preventive measure diabetics can take to maintain good health. Close monitoring of glucose levels can help reduce visits to physicians and care for related health problems such as diabetic retinopathy, kidney disease, high blood pressure or heart problems. However, barriers to self-monitoring are expense, time management and physical pain.

Lack of education about diabetic aids also is a problem especially among recently diagnosed diabetics. HME providers and manufacturers are becoming proactive by expanding product lines and educating patients about available products. New technological advancements have made it easier for diabetic patients to more often monitor their sugars.

Two affordable and easy-to-use tools are blood glucose monitoring kits and electronic software such as meal planners. Glucose monitors enable diabetics to monitor their sugars on a daily basis and provides them a regular and consistent way to maintain good glucose levels.

There are several brands of glucometers, and many have telecommunications capability for tracking purposes. Software enables patients to download information to their computer through compatible glucose monitors and eliminates the need to write down sugar levels, insulin amounts and food records.

While glucometers help reduce expenses related to maintaining sugar control and help eliminate time-consuming record taking, almost all require drawing blood to measure the glucose level. This is a painful procedure some diabetics face four or five times daily, and it can leave fingertips tender and sore.

Alternatives using non-invasive procedures measure glucose levels in saliva or urine, but these alternatives are less accurate than the more common blood glucose measurement, according to doctors and researchers. However, new technology has led to a non-invasive way to measure glucose with lasers.

CellRobotics, Albuquerque, N.M., introduced a personal lasette. The Lasette is designed to minimize pain and eliminate the need for needlesticks. The Lasette is lightweight and portable, and it eliminates sharps disposal, which can be costly and inconvenient. The Lasette has 15 different power settings to help ensure an adequate sample is obtained. The company is working at marketing the Lasette through traditional pharmacies and HME providers to expand its use.

"Its major benefit is that there is a lack of soreness associated with needlestick procedures," said Dr. Ron Lohrding, president and CEO, Cell Robotics.

A non-invasive method awaiting approval by the Food and Drug Administration (FDA) is Cygnus' Gluco Watch. This wristwatch-size device uses a consumable transdermal pad called an AutoSensor. It works through a process called reverse iontophoresis. This process allows the monitor to collect glucose samples from interstitial fluid through intact skin by application of a low electric current eliminating both pain and time restraints, according to Cygnus.

Another painful procedure associated with glucose monitoring is a test known as the hemoglobinA1c. This test serves as a report card for diabetic patients because the doctor is able to test sugar levels during a 90-day period.

However, this process requires the patient to have blood drawn from a fingerstick. ORNL and SpectRx are developing a painless A1c test, which awaits FDA approval, but the test will eliminate the pain of needlesticking every three months. The pain-free test will measure light emission from an illuminated eye, according to SpectRx.

"We believe that our system will have several advantages over the current hemoglobinA1c test. It will be noninvasive, much faster and cheaper. It will produce no hazardous waste that is costly to dispose of, and it will eliminate exposure to blood-borne pathogens," said Mark A. Samuels, president of SpectRx.

New Technology

New technological advances are abundant as researchers and providers search for answers to control the increasing cost of diabetes maintenance. Many companies are launching new products to further advance home health aids for diabetics.

Animas Corp. is marketing a new insulin pump, but they are also developing a laser system that can test blood glucose rather than glucose oxidase like other devices. The sensor directly reads glucose in the blood by means of a tiny near-infrared detector that is surgically placed around a single blood vessel, according to Animas.

Integ is working on a device that measures small amounts of fluid by placing a 1.4-millimeter hole in the dermis to obtain a sample. No blood is drawn, which causes far less pain that today's lancets, according to Integ.

The device is pressed against the skin on the forearm for less that 30 seconds to obtain a reading. A small, hollow lancet collects a tiny drop of interstitial fluid to obtain the reading. This method, in scientific experiments, proved to have closer readings to that of blood glucose than other methods, according to Integ researchers.

The TD Glucose Monitoring System from Technical Chemicals & Products, Pompano Beach, FL, uses a disposable patch on the skin to sample interstitial fluid, which is ready by a small handheld meter. The patch is estimated to be the size of a nickel and packaged in a pouch that also serves as a means of disposing the patch once used. The patch must be on the skin for about 5 minutes before a reading can be taken. A tab is then removed from the patch, and the measurement is obtained from the TD Glucose meter on the area of the patch where the tab was removed.

Patient Education

While many new trends and technological advances will help reduce costs of diabetic maintenance, the ultimate responsibility lies with the patient. Proper maintenance and good glucose levels can help reduce the costs of other medical problems associated with diabetes such as yeast infections in women, kidney failure, heart disease and foot problems.

HME providers can serve their patients by educating them about the value and techniques for appropriate management. Diabetic care centers are becoming more prevalent as reimbursement is increasing for diabetes-related products and HME providers will need to be "all-inclusive" in product selection to meet their patients' complete needs, according to Jack Evans, president, Global Media Marketing.

Potential marketing strategies include educational information expanding on consumers' knowledge about health-related conditions, expansion of products and information regarding insurance and reimbursements. Educating patients also serves an opportunity for providers to cross sell other products such as diabetic socks.

Using new technological advances and in working with their health care providers, diabetics may find it cheaper, less time-consuming and less painful to monitor their glucose levels and maintain long and healthy lives. New technologies and trends and an emphasis on educating patients will enable providers to turn diabetic maintenance into a profitable venture for both patient and provider.

Simple maintenance is a life time commitment and if companies are going to participate, they must be willing to commit themselves to providing current and cost-efficient education and products for their diabetic consumers.

This article originally appeared in the February 2000 issue of HME Business.

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