DexCom - Continuous Glucose Monitoring
Filed under: Type 1, Childhood, Lifestyle, Products, Support
DexCom has developed a continuous glucose monitoring ("CGM") system that could be the next generation of aggressive control. The DexCom GCM is a device that measures glucose trends throughout the day, providing up to 288 glucose measurements every 24 hours.
A traditional glucose monitoring test -like finger sticks - leave gaps in time where you are uncertain as to your blood sugar reading. Continuous monitoring is different from traditional blood glucose monitoring because it affords a comprehensive picture of where your blood sugars are throughout the day and night. The trend reveals times throughout the day where your sugar may increase or decrease, as well as how fast it is happening. This trend information together with the glucose value shows you patterns and problems that traditional finger sticks cannot cover as thoroughly. CGM allows you to set a target range for your desired glucose. When your glucose goes above or below this range, an alert automatically lets you know.
A 2006 study showed that people who used this device were able to achieve a 23% decrease in time spent high and a 21% decrease in time spent low. After speaking with Dianne on the DexCom customer support line - she advised me that they are offering a $375 startup kit that has everything you need to get going. The Rechargeable STS Receiver has a sleek rounded design that can easily be carried with the carry case on both your belt or in a handbag. The STS Transmitter is lightweight and fits comfortably underneath clothing. The STS Sensor & Applicator is easy to insert and safe to use with no visible needles or exposed sharps. With this wireless system, no cables or wires will get in your way allowing you to Take Control and Live Uninterrupted.. Each sensor lasts for 3 days. A set of 5 sensors costs $175 and will last you approximately 15 days.
The annual cost of continuous glucose monitoring averages a ballpark figure of $4,258. Okay, sounds a little steep - but lean on Uncle Sam to offset the cost of the best control. Sounds like it might be time to open up a Flexible Spending Account and write-off the yearning for glucose precision.
[RESEARCH] The impact of response to the results of diagnostic tests for malaria: cost-benefit analysis
Objective Rapid diagnostic tests for malaria seem cost effective in standard analyses, but these do not take account of clinicians’ response to test results. This study tested the impact of clinicians’ response to rapid diagnostic test or microscopy results on the costs and benefits of testing at different levels of malaria transmission and in different age groups.
Design Cost-benefit analysis using a decision tree model and clinical data on the effectiveness of diagnostic tests for malaria, their costs, and clinicians’ response to test results.
Setting Tanzania.
Methods Data were obtained from a clinical trial of 2425 patients carried out in three settings of varying transmission.
Results At moderate and low levels of malaria transmission, rapid diagnostic tests were more cost beneficial than microscopy, and both more so than presumptive treatment, but only where response was consistent with test results. At the levels of prescription of antimalarial drugs to patients with negative tests that have been found in observational studies and trials, neither test methodis likely to be cost beneficial, incurring costs 10-250% higher, depending on transmission rate, than would have been the case with fully consistent responses to all test results. Microscopy becomes more cost beneficial than rapid diagnostic tests when its sensitivity under operational conditions approaches that of rapid diagnostic tests.
Conclusions Improving diagnostic methods, including rapid diagnostic tests, can reduce costs and enhance the benefits of effective antimalarial drugs, but only if the consistency of response to test results is also improved. Investing in methods to improve rational response to tests is essential. Economic evaluations of diagnostic tests should take into account whether clinicians’ response is consistent with test results.
Socioeconomics' role in heart disease
Filed under: Diet, Research, Obesity, Nutrition, Exercise, Smoking
What risk factors come to mind when you think of heart disease? Excessive body weight, sedentary lifestyle, poor diet, diabetes, smoking -- those seem to be universally accepted. But, a recent study published in the February issue of the American Journal of Preventative Medicine suggests that there is a risk factor that you may not have taken into account: Living in a low-income neighborhood.
Researchers from Stanford University examined data for the entire Swedish population, which consists of roughly 1.9 million women and 1.8 million men, all spread across more than 8,000 neighborhoods. Of the people selected for the study, they were all free of any prior history of coronary heart disease. They followed these individuals from 1996 through 2000 to identify initial occurrences of heart disease and subsequent deaths from it within a year's time.
It was discovered that the new cases of heart attacks and strokes were almost twice as high for women and 1 and a half times higher for men who lived in "high-deprivation" neighborhoods as those living in what were deemed "low-deprivation" neighborhoods. To determine what was considered low or high deprivation, the researchers relied on Census data, measuring an index of income, education, unemployment and welfare assistance.
Lending further credibility to the findings was the fact that even when individual characteristics (such as age, family income, marital status, or immigration status) were taken into account, the results remained unchanged.
The belief behind the findings is that people living in poorer neighborhoods have less access to fresh produce markets, and greater access to fast food restaurants. Ability to pay for higher priced, healthier foods also seems to be a major factor behind the researchers' data.
Diabetes hits hard in New York City
Filed under: Type 2, Research, Daily News, Support
It's a pretty well-known fact that type 2 diabetes is hitting New York City hard. And the powers-that-be in the City are doing something about it: New York City was the first place in the nation to initiate a diabetes-tracking registry intended to guide healthcare spending to maximum effect.So, just how bad is the situation? The city's health department just completed a major study on that very topic and made the results public this week. Some numbers: diabetes causes 20,000 hospitalizations, 3,000 amputations, 1,400 cases of kidney failure, and 4,700 diabetes-related deaths annually. The financial cost of treatment is a staggering $6.5 billion annually.
The report clearly shows that people in lower socioeconomic groups, clustered in a handful of poorer neighborhoods, are suffering disproportionately to the well-heeled and well-educated residents of the chic Upper East Side.
As is the case everywhere in the US - not to mention, globally - a great many people with type 2 diabetes or who are at risk for the disease do not know it, and city officials are aiming to exponentially increase awareness in coming years. The entire report is accessible online in PDF-form at the NYC Department of Health and Mental Hygiene's website.
New book suggests obesity is all in the genes
Filed under: Type 1, Type 2, Childhood, Adult Onset, Diet, Lifestyle, Exercise, Books, Support, Care
This past spring a new book by Gina Kolata, a science reporter for the New York Times, hit the scene -- Rethinking Thin: The New Science of Weight Loss - and the Myths and Realities of Dieting. I came across a mention of the book in the blogosphere and had to check it out. I have personally not read the book yet, but I have poured over newspaper and reader reviews.
In Rethinking Thin, Kolata argues being fat is biological destiny. She says most overweight people are stuck within a relatively narrow weight range set by their genes. But as obesity rates have steadily risen and the phrase 'obesity epidemic' sails across the news waves, the pressure to eat healthy, exercise and lose weight screams in response.
Kolata notes dieters only manage to keep off a little weight, sharing scientific evidence to explain this constant, disappointing phenomenon. Fat people have more fat cells, and while their metabolisms are normal, their appetites are larger. Losing significant weight often triggers a powerful "primal hunger." Furthermore, studies on twins and adopted children show inheritance may account for up to 70 percent of weight variance. Kolata leans heavily on the influence of genetics -- questioning the popular belief 'fat people can become thin if they would only apply themselves.' A similar argument is often applied to overweight people with type 2 diabetes -- 'just lose the weight already and you will be cured!' But if obesity is nearly all genetic, why are we getting fatter and fatter?
Emily Bazelon's book review in the New York Times is a nice overview of Kolata's arguments. Bazelon throws out a few challenges, pointing out Kolata ignores the influence of the 'gazillion-dollar food industry'. She also questions Kolata's speculation that obesity might be a response to modern medical advancements -- that our nation's improved early nutrition, vaccines or antibiotics might somehow change the brain's control over weight. This is an interesting line of thought, very different from the concept that our ancestral caveman's between-the-hunt survival biology simply cannot handle our country's overabundance of cheap, calorie-laden cuisine consumed in a car.
Big bucks for insulin not worth it, says German government
Filed under: Drugs, Daily News
So the price of drugs just seems to keep on climbing. And sometimes I wonder if the sky really is the limit in terms of the prices we are expected to pay. I, for example, just filled a prescription and received a tiny bottle the size of a purse-pack-sized bottle of eye drops. And how much did I pay? $25. Yes, and that's with insurance. It's insane. But it's not happening everywhere. In western Europe, where publicly-owned, government-run health care systems are the norm, people are putting the squeeze on the big pharmaceutical companies. Let's look at insulin. A while ago there was a kerfuffle in the UK when government advisers overseeing the National Health Service basically said "no, thanks" to Pfizer's inhalable insulin, Exubera. Too expensive, they said. Now, Germany. This week, the biggies - Eli Lilly, Novo Nordisk and Sanofi-Aventis - decided to slash the cost of their insulin products in Germany. Why? Officials from Germany's health ministry say the new fast-acting versions of insulin just aren't worth the money. That left Big Pharma with little option but to play ball anyway, by cutting prices by up to thirty percent. For Novo Nordisk, this means a projected loss of $14.5 million in sales this year, reports Bloomberg.com. According to this article, the German government is, in this regard, following in the footsteps of the UK and the US. In effect, this means trying to cut spending by carefully weighing the costs of specific drugs against their benefits, rather than just picking up the tab willy-nilly.
Bottom line? Market expert Mark Belsey says the big drug producers will have to adapt as the tide turns, spending a lot more time and money justifying the worth of their products. This new strategy, he says, will come at the expense of what used to be their main focus: creating and marketing fancy new mega-drugs.
[RESEARCH] Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial
Objective To determine whether introducing a rapid test for meticillin resistant Staphylococcus aureus (MRSA) screening leads to a reduction in MRSA acquisition on hospital general wards.
Design Cluster randomised crossover trial.
Setting Medical, surgical, elderly care, and oncology wards of a London teaching hospital on two sites.
Main outcome measure MRSA acquisition rate (proportion of patients negative for MRSA who became MRSA positive).
Participants All patients admitted to the study wards who were MRSA negative on admission and screened for MRSA on discharge.
Intervention Rapid polymerase chain reaction based screening test for MRSA compared with conventional culture.
Results Of 9608 patients admitted to study wards, 8374 met entry criteria and 6888 had full data (82.3%); 3335 in the control arm and 3553 in the rapid test arm. The overall MRSA carriage rate on admission was 6.7%. Rapid tests led to a reduction in median reporting time from admission, from 46 to 22 hours (P<0.001). Rapid testing also reduced the number of inappropriate pre-emptive isolation days between the control and intervention arms (399 v 277, P<0.001). This was not seen in other measurements of resource use. MRSA was acquired by 108 (3.2%) patients in the control arm and 99 (2.8%) in the intervention arm. When predefined confounding factors were taken into account the adjusted odds ratio was 0.91 (95% confidence interval 0.61 to 1.234). Rates of MRSA transmission, wound infection, and bacteraemia were not statistically different between the two arms.
Conclusion A rapid test for MRSA led to the quick receipt of results and had an impact on bed usage. No evidence was found of a significant reduction in MRSA acquisition and on these data it is unlikely that the increased costs of rapid tests can be justified compared with alternative control measures against MRSA.
Trial registration Clinical controlled trials ISRCTN75590122.
[RESEARCH] Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review
Objectives To determine the diagnostic accuracy of duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography, alone or in combination, for the assessment of lower limb peripheral arterial disease; to evaluate the impact of these assessment methods on management of patients and outcomes; and to evaluate the evidence regarding attitudes of patients to these technologies and summarise available data on adverse events.
Design Systematic review.
Methods Searches of 11 electronic databases (to April 2005), six journals, and reference lists of included papers for relevant studies. Two reviewers independently selected studies, extracted data, and assessed quality. Diagnostic accuracy studies were assessed for quality with the QUADAS checklist.
Results 107 studies met the inclusion criteria; 58 studies provided data on diagnostic accuracy, one on outcomes in patients, four on attitudes of patients, and 44 on adverse events. Quality assessment highlighted limitations in the methods and quality of reporting. Most of the included studies reported results by arterial segment, rather than by limb or by patient, which does not account for the clustering of segments within patients, so specificities may be overstated. For the detection of stenosis of 50% or more in a lower limb vessel, contrast enhanced magnetic resonance angiography had the highest diagnostic accuracy with a median sensitivity of 95% (range 92-99.5%) and median specificity of 97% (64-99%). The results were 91% (89-99%) and 91% (83-97%) for computed tomography angiography and 88% (80-98%) and 96% (89-99%) for duplex ultrasonography. A controlled trial reported no significant differences in outcomes in patients after treatment plans based on duplex ultrasonography alone or conventional contrast angiography alone, though in 22% of patients supplementary contrast angiography was needed to form a treatment plan. The limited evidence available suggested that patients preferred magnetic resonance angiography (with or without contrast) to contrast angiography, with half expressing no preference between magnetic resonance angiography or duplex ultrasonography (among patients with no contraindications for magnetic resonance angiography, such as claustrophobia). Where data on adverse events were available, magnetic resonance angiography was associated with the highest proportion of adverse events, but these were mild. The most severe adverse events, although rare, were mainly associated with contrast angiography.
Conclusions Contrast enhanced magnetic resonance angiography seems to be more specific than computed tomography angiography (that is, better at ruling out stenosis over 50%) and more sensitive than duplex ultrasonography (that is, better at ruling in stenosis over 50%) and was generally preferred by patients over contrast angiography. Computed tomography angiography was also preferred by patients over contrast angiography; no data on patients' preference between duplex ultrasonography and contrast angiography were available. Where available, contrast enhanced magnetic resonance angiography might be a viable alternative to contrast angiography.
A few heart healthy tips
Filed under: Diet, Prevention, Mind Body medicine
I usually tune in to CNN to find out what's going on in the world, not to find out what's going in inside my body. But, there are always exceptions. For example, I find the BBC news to sometimes be a more accurate/less filtered account of world events. By the same token, CNN does have some valuable health info. to offer up every once in a while. Case in point, a list of "9 Secrets to a Healthier Heart" published on the news giant's website.
Simple, easy-to-follow and just plain good, sound advice. That's what I like most about this list. Rather than reiterate all of the 9 secrets, I have instead decided to paraphrase a few I found to be most helpful:
#4) Try to consume more pomegranate juice. In addition to aiding in preventing hardening of the arteries, lowering bad cholesterol, pomegranate juice may also reduce the risk of prostate cancer. Try to find a 100% version of the juice, such s the very popular Pom -- which can be found in most supermarkets.
#6) Pointing to a research study conducted at the University of Maryland School of Medicine in Baltimore, the article sites the importance of laughter. Its healing power, if you will. Apparently, people who watched comedy films such as "There's Something About Mary" had better blood flow than those who watched dramas like "Saving Private Ryan."
#8) Relaxed, control breathing can help lower your blood pressure. The article suggests trying to take 10 breaths per minute rather than the average 16 to 19. By doing so, you can slow your body's excretion of salt, which, in turn, will help keep your blood pressure down.
As I said, these are simple and effective strategies to help keep your heart healthy. To read all 9, click HERE.
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The Dilemma: which disease is more worth treating?
Filed under: Research
Fight infectious diseases or treat chronic illnesses? Which of the two do you choose? This is the very dilemma faced by many third world nations, with economic shortfall being the cause for such a decision to be made. So, with little alternative but to make a choice, many poor countries have focused their medical attention to preventing the spread of communicable diseases. As expected, this has left people suffering from chronic non-communicable conditions such as cardiovascular disease and cancer with few treatment options.
In the January 18, 2007 issue of the New England Journal of Medicine, Gerard Anderson, PhD, a professor from the Johns Hopkins Bloomberg School of Public Health, addressed the dire need for more international aid for chronic, non-communicable diseases in these poorer countries. He cites facts surrounding the dangers of not properly treating such diseases, and also highlights statistics showing cardiovascular disease as being the cause of 27 percent of all deaths in poor countries, whereas HIV/AIDS, malaria, and tuberculosis combined only account for 11 percent of deaths in poor countries.
The professor is quick to point out that he does not feel as though aid for communicable diseases should be cut. Rather, he feels that an equal amount of resources should be made available for chronic, non-communicable diseases, as well. As for a reason why the former receives more attention than the latter, he posits that it may be related to the fact that the world fears the world fears the global spread of communicable diseases, a danger that is not attributed to chronic, non-communicable disease. Also, in many cases chronic, non-communicable diseases are not viewed as being of great urgency, so they do not receive an equal amount of media attention.
For more information, review Dr. Anderson's article, "Expanding Priorities -- Confronting Chronic Disease in Countries with Low Income" in the January edition of the New England Journal of Medicine.