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New device helps diabetics, doctors plan treatment
New technology is making it much easier for diabetic patients to monitor their blood sugar levels and then take action to keep it under control.Typically, Dr. Douglas Thrasher of Piedmont Family Practice explained, patients with diabetes monitor their glucose levels through fingerstick measurements, taking samples maybe three or four times a day.
The problem, he said, comes when those readings don’t mesh with the patient’s glycated hemoglobin test. That test, according to the American Diabetes Association, measures the amount of glucose that has ‘hooked up’ with hemoglobin over a two to three month period. The association’s Web site describes the test with a baseball analogy, noting that it is much like a batter’s average for the season as opposed to a fingerstick, which might represent one at bat.
Where there’s a discrepancy between the batter’s average and the at-bats, footage of the game would be helpful in understanding what’s going on between innings. That footage is now available through a new continuous glucose monitoring system offered by Medtronic.
The device fills in the gap between these current methods of measurement, said Thrasher, who joined the staff at Piedmont five months ago, having come from the Fauquier Medical Associates practice in Bealeton.
“Now we can witness these excursions and adjust [the patients'] regiment,” Dr. Steven von Elten added.
About the size of a quarter, the monitor is attached, painlessly, to the patient’s abdomen, where a sensor under the skin takes up to 288 glucose readings a day, said Sue Ann Fischer, senior diabetes territory manager for Medtronic Diabetes.
After three days, the monitor’s hard drive is removed at the doctor’s office, again, without pain, and the data is downloaded to the physicians’ computer. The result is a comprehensive charting of the patient’s glucose levels, including spikes and drops, over the last 72 hours.
“We like to say that fingersticks are one frame and this is a moving picture,” said Fischer.
That data, combined with information provided by the patient on diet, exercise, and stress levels offers a much more complete view of the cause-and-effect relationship between daily activities and glucose levels, Medtronic literature explains. Whereas previous testing methods might have missed the patients' sugar highs and lows, the continuous monitoring system charts them clearly.
Linda White, a diabetic patient from Warrenton, had the new monitor attached Monday. “Is it on yet?” she asked, saying she felt no pain from the insertion of the sensor. Diagnosed with diabetes two years ago, White is hopeful that the new monitor will help her avoid insulin shots.
“I’m more anticipatory than anything. I want to see what the data is and then work to change it so I don’t have to go on insulin,” said White, who is currently measuring her blood sugar through fingerstick readings and using diet, exercise, and oral medication to keep it in check.
A processor for FEMA, White travels frequently for business, which makes sticking to an exercise and diet plan more difficult. She has been a patient of Thrasher’s since 1999.
“I don’t want to commit to insulin. I’m hoping to get to a point where I can flip it back the other way,” she said.
While the monitor is attached, White will keep track of what she eats, when she eats, exercise, and stress levels. She will also take four fingerstick tests a day so that Thrasher can compare those tests with the continuous monitor.
“Then we’ll come up with what we need to do to keep you off of insulin,” Thrasher encouraged.
When she returns to the practice, White will also meet with Joanna Barefoot, the backbone of Piedmont’s diabetes program.
Recognizing the significance of diabetes as a major health issue, Piedmont Family Practice started efforts several years ago to offer more education to its diabetic patients, explained von Elten.
Barefoot, a registered nurse, dietitian, and certified diabetes educator, works with patients and their families to prevent diabetes by improving patients’ diet, increasing exercise, and monitoring blood sugar. Helping patients lose weight while maintaining and strengthening muscle mass is one of Barefoot's primary objectives.
“We brought her in to do nutritional counseling. It was not being done appropriately, even at places like Johns Hopkins or Duke. What she’s doing is state of the art,” said von Elten, noting that Johns Hopkins and Duke have both implemented programs that follow the principals used by Barefoot.
Barefoot met von Elten when she was in nursing school and, in 2001, the two talked about her joining the practice. “He said they needed somebody to work with chronic disease management,” she said, noting that she works with both diabetic and pre-diabetic patients.
“I work a lot with targeting people with obesity and elevated cholesterol so we see them before their blood sugar is at diabetic levels,” she said.
Certified by the American Association of Diabetes Educators (AADE) since 2004, Barefoot participates in national conferences and local seminars to keep abreast of the newest treatment modalities available through both medications and lifestyle modifications of diet and exercise. She is a certified pump trainer and recently earned the designation of First Line Therapy Certified Educator.
Barefoot sees her primary job as one of counseling patients and their families. “I've been a registered nurse for more than 20 years and I've worked in a lot of different modalities,” Barefoot said. “I have just a ton of experience that plays into counseling every day.”
Helping patients adjust their lifestyles is no easy task. “Life happens. There are so many factors that influence a person's lifestyle,” she said. “You have to be a good listener and trouble-shoot. It's not just all about facts and figures. It takes a lot of years of accrued experience and just the love of people.”
It doesn't hurt, Barefoot added, that her patients have been ordered by the physicians to make significant changes. “We have a higher than usual success rate because it is physician-ordered. This comes through as a credible, health professional program,” she said.
According to the American College of Endocrinology, 24.1 million Americans over the age of 20 now have diabetes, an increase of more than three million in approximately two years. Another 57 million have pre-diabetes and the yearly cost associated with the disease is $174 billion. Complications from diabetes include heart disease, stroke, high blood pressure, blindness, kidney disease, nervous system diseases, amputations, dental disease, and pregnancy complications. Though the Centers for Disease Control believes diabetes as a cause of death is underreported, it ranked seven in the United States in 2006.
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