Blog | Tuesday, April 21, 2009

A collection of diabetes tidbits

I spent today at an Internal Medicine 2009 precourse on diabetes and picked up a lot of miscellaneous interesting info, particularly during the session by Irl Hirsch, FACP, on monitoring in diabetes.
  • Most common reason that patients' finger-sticks are inaccurate? They don't wash their hands beforehand. If you eat an orange, then test blood from one of your sticky fingers, the glucose from the fruit could make the result inaccurately high.
  • But should your type 2 patients who aren't on insulin even be bothering to self-monitor? Given that there's no proof that home testing affects outcomes and test strips are expensive, Dr. Hirsch sees the main use being special occasions, like when a patient is eating something new and wants to see how her blood sugar responds.
  • A1cs are good, but not perfect. Anemia, in particular, can make their results inaccurate. Also, did you know that half of an A1c result is determined by glucose levels over the previous 30 days?
  • The newest big thing in diabetes monitoring--real-time continuous glucose monitors. They work great (i.e., significantly lower A1cs) if patients wear them all the time and pay attention to them, Dr. Hirsch said. Best used by patients and physicians who are tech-savvy and willing to devote some real time and attention.
  • The next big thing, however, could turn out to be a very old thing--urine glucose testing. If a currently underway study proves that it's as effective as home blood testing, payers could push for a move back to the older, cheaper option.
  • In the afternoon, David Kendall, MD, made a convincing case for incretin-based therapies. In addition to improving insulin secretion and response, the drugs reduce food intake and cause weight loss. So how to decide if exentide and the other on-their-way-to-market options in the class are right for your patients? That was a little fuzzier--you'll know 'em when you see 'em was the gist of his message.