Selecting A Blood Glucose Meter
By Gary Scheiner MS, CDE
Everyone with diabetes knows how important it is to monitor blood sugar levels. Point-in-time blood sugar measurements are necessary to know what's working and what isn't. They help healthcare providers determine optimal forms of treatment, and guide people with diabetes in day-to-day decisions regarding food, activity, and insulin/medication doses.
To make life with diabetes safer and better, your blood glucose meter will get a lot of use. Whether you're selecting your first blood glucose meter or are looking to upgrade your existing one, it is important to select a device that will meet your individual needs… and your budget. Although all blood glucose meters must meet certain governmental standards, there are many differences between them. Here are a few key features to consider:
Accuracy — All meter manufacturers publish data about the accuracy of their devices on their websites or in the "specifications" section of the user manual. Accuracy is measured in a number of ways: The percentage of readings that are within 10% or 15% of laboratory values; the percent of readings that are within very close proximity (usually 10 mg/dl or .5 mmol/l) of the lab value when the blood sugar is in a hypoglycemic range; and the overall average difference (expressed as a percentage) between the meter values and lab values – called mean relative absolute difference, or MARD. How much accuracy do you need? If you don't take insulin or medications that can cause hypoglycemia (sulfonylureas or meglitinides), accuracy in a hypoglycemic range is irrelevant. A MARD of 10-15% is usually accurate enough to tell you what you need to know. However, if you are at risk of hypoglycemia or adjust your mealtime insulin based on your blood glucose values, a MARD of 5% or less is highly desirable.
Cost — When considering the cost of blood glucose monitoring, one must look beyond the price tag on the meter itself. In most cases, meter manufacturers provide medical offices with a large supply of free meters to pass along to patients, and many offer coupons for free meters when they are purchased at a pharmacy. The real cost is in the test strips, which are used and changed each time a reading is taken. Public health plans such as Medicare have taken steps to limit the price manufacturers can charge for test strips, and some private plans offer better coverage for certain brands. Still, there are almost always copays and deductibles that must be met. Generic meters/strips and "preferred brands" tend to cost much less, but they also tend to sacrifice accuracy and convenience/usability features. So regardless of the type of health insurance you have, it pays to shop around.
Speed — The time it takes for a meter to produce a reading is important because we all have things to do besides tending to diabetes. And the more often you check, the more important it is to have a fast meter. In fact, if you check your blood sugar four times daily, switching from a meter that takes 15 seconds to one that takes 5 seconds will save you more than four hours per year just waiting for readings to appear!
Meter Size — As long as your vision is good, smaller is usually better. It is important that meters be portable so that you can carry them with you and check anytime, anywhere. Also keep in mind that the size of the test strip vial and lancing device will affect how much you need to carry. Some meters are a bit on the large size but have the test strips and lancing device built right into the meter. And some meters use test strips that are individually foil-wrapped, which can save considerable space.
Blood Volume — Current meters require 0.3 microliters (ml) to more than 1.0 ml of blood to properly dose the test strip. The less blood a meter requires, the easier (and less painful) it is to obtain the blood sample, and the less likely you are to waste strips due to under-dosing the strip. For those who prefer to obtain a blood sample at an "alternate site" (forearm, leg, etc.), it is best to use a meter that requires 0.5 ml of blood or less.
Simplicity — Some meters require button pushes and "coding" before a test can be performed. Others require no coding (test strips are manufactured under uniform conditions) and do not require any button presses to do a basic blood glucose check – just insert the strip and apply the drop. Some meters have multiple test strip "packets" integrated into the meter so that strips don't have to be inserted into the meter every time you check. In addition, keeping the meter powered varies from system to system. Some meters use common disposable batteries, while others require hard-to-find lithium batteries. Many newer meters contain rechargeable batteries (similar to a cell phone) – simply plug into a computer or wall outlet for a periodic recharge.
Display/Communication — Many meter manufacturers are moving towards full-color, high-contrast screens that are easier for the user to read. Some have incorporated touch-screen technology for programming the meter and reviewing data in the meter's memory. For those with very limited (or no) vision, a talking meter allows for much greater independence. Meters are now available that feature audible messages and specially imprinted tactile buttons.
Logging Capability — The ability to record more than just glucose values can turn any meter into a complete record-keeping system. Many meters allow the user to "tag" readings as pre- or post-meal, and some allow for the entry of more detailed information, such as food/carbs, exercise, and insulin/medication doses.
Data Analysis/Feedback — It's one thing to perform blood glucose checks, but it's another to gather the data, analyze it, and form conclusions that can be used to improve control. Downloading meter data to a computer can provide valuable information (and time savings) for you and your healthcare team. Most non-generic meters are downloadable to a computer, and some have simplified the process by incorporating "plug and play" technology: the software for downloading the meter is built right into the meter itself. There are even meters that provide automated feedback based on recent glucose values: messages are displayed if a trend of above- or below-target readings is detected over a period of time.
Pump Link — For those who use an insulin pump and utilize the pump's bolus "calculator" to determine insulin doses, it helps to have a meter that communicates directly with the pump. This ensures the accuracy of calculations and saves the user time each time a bolus dose is determined. Some pumps link with only one type of meter, others link with more than one. Check with your pump manufacturer to determine your options.
Gary Scheiner is the 2014 AADE Diabetes Educator of the Year and author of "Think Like A Pancreas". He has had type 1 diabetes since 1985, and offers diabetes management consulting services worldwide via his website, www.integrateddiabetes.com.
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