Home blood glucose monitoring

Commercially, the preferred tools for sensing complex molecular species have relied on the high specificity exhibited by antibodies and enzymes. Most clinical systems currently available for measuring blood glucose levels rely on the glucose oxidase enzyme (GOx, also commonly abbreviated to GOD or GO). 

There can be no question that the availabihty of affordable home blood glucose monitoring has revolutionised the quahty of life experienced by diabetics. However, there are some inherent limitations with an enzymatic approach. The systems have to be stored appropriately, they are specific only for a few saccharides and in most cases they become unstable under harsh conditions and hence cannot be sterilised. For this reason, much work has been focused on the development of synthetic sensors with the capacity to monitor saccharides under a broad range of environmental conditions, and thus allow access to a wider spread of diagnostic applications. 

---

Clinical utility takes the concept a step further and shows that the patient s medical outcome is favorably influenced by knowledge of the diagnostic test. An example would be that the tight insulin control that is only possible with frequent home blood glucose monitoring has a positive impact on delay of complications of diabetes. FDA does not require that a demonstration of clinical utility be performed in support of submissions but does... 

Patient motivation and interest Diet compliance and carbohydrate counting Frequent home blood glucose monitoring (generally four to six times per day)... 

Home blood glucose monitoring is recommended for all patients on antidiabetic medications, particularly insulin, If values are below 4mmol/L or persistently above 15 mmol/L, patients should seek immediate medical advice. Self-monitoring is usually offered to those with type 2 diabetes as an integral part of self-management education,... 

The U.S. Market for Home Blood Glucose Monitoring products, www.findsvp.com/tocs/ML0392.htm. 

Tate PF, Clements CA, Walters JE. Accuracy of home blood glucose monitors. Diabetes Care 1992 15 ... 

Urdang M, Ansede-Luna G, Muller B, Newson R, Lacy-Pettit A, O Shea D. An independent pilot study into the accuracy and reliability of home blood glucose monitors. Lancet 1999 353 1065-6. 

Major medical literature publications on home blood glucose monitoring with portable meters... 

The majority of these home blood glucose monitoring tools rely on the invasive withdrawal of blood, typically from a pricked finger, followed by application of the sample to an amperometric enzymatic test strip allowing GOx to catalyse the oxidation of glucose to gluconic acid (see Scheme... 

Home/self blood glucose monitoring, HbAj,, signs and symptoms of hyper/hy-poglycemia, complete blood count, routine blood chemistry... 

FIGURE 33-19 Photograph of a blood glucose monitor for in home use. The meter (a) contains the electronics and display. A droplet of blood is placed on a test strip (b). which is placed at the top of the meter. The test strip contains immobilized glucose oxidase and electrodes for the amperometric detection system. (Courtesy of Life-Scan. Inc., Milpitas. CA.)... 

With the introduction of modern electronics, inexpensive computers, and new materials there is a resurgence of voltammetric techniques in various branches of science as evident in hundreds of new publications. Now, voltammetry can be performed with a nano-electrode for the detection of single molecular events [1], similar electrodes can be used to monitor the activity of neurotransmitter in a single living cell in subnanoliter volume electrochemical cell [2], measurement of fast electron transfer kinetics, trace metal analysis, etc. Voltammetric sensors are now commonplace in gas sensors (home CO sensor), biomedical sensors (blood glucose meter), and detectors for liquid chromatography. Voltammetric sensors appear to be an ideal candidate for miniaturization and mass production. This is evident in the development of lab-on-chip... 

Glucose sensors are mainly used to determine blood glucose in clinical chemistry and diabetes home monitoring. The detection limit is around 1 pM and increases by additional diffusion barriers for undiluted whole-blood measurement and in-vivo application. Typical response times are below one min. Screen-printed electrodes are often made for single use. Entrapment of GOD in polyurethane and amperometric indication of hydrogen peroxide may result in a massively stabilized glucose sensor which may be reused more than 1000 times. 

Doctor, nurse and patient are faced with a lifetime of collaboration. Compliance is not a one-sided process, and the patients need all the consideration and support they can get. They should learn about their disease and its management, including home monitoring of blood glucose, and about the need for appropriate diet, exercise and avoidance of smoking. 

HPI DK is a 62-year-old woman with type 2 diabetes for 5 years. She has been treated with giyburide for 4 years. She follows dietary recommendations (low fat distributes carbohydrates throughout her three meals a day) to the best of her ability and walks 30 minutes three times weekly. At a routine veit with her primary care provider, her FBG is 180 mg/dL. She does not monitor her blood glucose at home and does not have a glucose meter. She is a nonsmoker and her father has type 2 diabetes. Her only long-term diabetes complication is background diabetic retinopathy. 

Portable meters for measurement of blood glucose concentrations are used in three major settings (a) in acute and chronic care facilities (at the patient s bedside and in clinics or hospitals) (b) in physicians offices and (c) by patients at home, work, and school. The last, self-monitoring of blood glucose (SMBG), used by approximately 1 miUion diabetic patients, is performed in the United States at least once a day by 40% and 26% of individuals with type 1 and 2 diabetes, respectively. The worldwide market for SMBG is 2.7 billion per year, with annual growth estimated at 10% to 12%. ... 

Glucose monitoring devices cleared by the FDA for home use Various Monitoring of blood glucose levels... 

---