When diabetic patients begin using a glucometer it represents a considerable life change, as this device plays a key role in ensuring whether diabetics will adhere to their treatment.
Also integral to treatment success, the HME provider plays a critical role in helping a diabetic to embrace the glucometer as a tool that will improve their quality of life..
“Diabetes itself is stressful,” says Kathy Ahearn, RN, BSN, and PHN, who has worked with many diabetic patients, including her own child, a type 1 diabetic. “Diabetes never goes away. When I have worked with patients and I have picked blood glucose meters for them, I try to match the patient with the meter that will cause less stress and anxiety.”
Struck by a condition that can be caused by genetics or lifestyle choices, diabetics become anxious because they must completely change their behaviors.
“They have to completely change their lifestyle,” says Ahearn, who also is director of managed care for glucometer maker Arkray USA. “You can’t pick up a snack without thinking ‘Uh-oh, I have to test.’ You lose that freedom. You can gain it back, but initially you lose it.”
So how can providers help patients ease into this transition to ensure compliance?
Know the patient. Diabetic patients’ learning curves are across the board. Depending on their support system, some patients might need more guidance from the provider than others. “Some families embrace it, and some people, including children with type 1, are left completely on their own to deal with this,” says Ahearn.
Know their disease process. New patients mean new learning curves. Glucometers with multiple programming functions and requirements will confound a newly diagnosed elderly patient and undermine compliance. Most patients will simply need a meter that can provide a quick reading, allowing them to focus on their eating habits and taking their medication.
Know their comfort with technology. If patients are computer savvy, they can use glucometers that plug into a PC via a USB cable and then upload their information to web sites that help them track their progress, provide online journaling and carbohydrates counting tools. They can even let their physician look at their data.
Introduce autocoding. Ensuring proper calibration is critical for accurate readings, says Dr. Rowena Maclin, DO, who after serving as a longtime medical director of one of the JPS Family Practice Residency Clinics is now starting a private practice. Auto coding helps ensure this happens. With glucometers with autocoding, patients don’t need to program in the type of strip they’re using for their tests. Instead, it will automatically key to that strip’s code simply by reading it.
Understand children’s concerns. “Kids don’t want to stick out and be different,” Ahearn says, adding that providers should consider matching young type 1 patients with glucometers that don’t look like typical glucometers. For instance, some meters look like cell phones or other portable electronic devices, providing some welcome camouflage.
Know what they can afford. “There are a lot of people without insurance trying to handle this disease,” Ahearn says. Cash-paying customers need affordable meters. Providers also should look for manufacturers that offer assistance programs for patients. Likewise, patients also need test strips that have longer shelf lives to minimize costly waste, Maclin says, adding that while glucometers can come relatively cheap, strips cost on average a dollar a strip, which means testing could cost patients four or five dollars a day.
Offer informational resources. Both organizations and some vendors provide printed and online support information for patients and for providers for distribution to patients. Some information is offered on DVD, which is particularly useful for helping instruct children.
Gauge literacy levels. DVDs also help patients with literacy problems. Additionally, providers should look at their local market for large patient segments of non-English-speaking patients. Third-party instructional materials are often available in Spanish and other languages to help them, as well.
Explain alternate site testing. Diabetics no longer have to prick their finger tips, which have the highest concentration of nerve endings in the human body, to take readings. Many glucometers let them test on their palms, forearms, or other, less painful areas. The pain of a finger stick test can be a hurdle for not only new patients, but seasoned diabetics, as well, Maclin and Ahearn note. The flip-sides to alternate site testing is that it can cause variation in readings from doing it at the finger tip, which also happens to be the best point in the human body for accessing capillaries.
Explain double-dosing. Sometimes on a first attempt, a patient might not get enough blood on the strip to take a reading. Rather than wasting that strip, glucometers with double-dosing features let them add a little more to the strip so that it can take a reading.
Points to take away:
• Diabetes is a major life change. Providers must help patients ease into this stage in their lives.
• Know your patients. Are they young? Old? Do they fear or embrace gadgets? Are there language difficulties? Are they cash-only?
• Know your blood meters. Do they offer features such as alternate site testing, autocoding and double-dosing to help ensure compliance?
• Know your resources. Non-profits, hospitals and even manufacturers provide various tools and reference materials to help new patients conform to treatments. Some even provide assistance programs for patients with no coverage.
