Using Diabetes Strips? It's Time for a Rethink

Sharmila Kher, Down to Earth INDIA-Although India is the diabetes capital of the world, few use medical devices for self-monitoring of blood glucose levels. Patients of type 1 diabetes, which is genetic, require regular monitoring. Ninety-nine percent of diabetics in India are of the type 2 variety, which is controlled by using a combination of insulin, glucose-lowering drugs, exercise and diet control. Blood sugar testing plays a small role in this. However, companies are now inventing a market by selling self-testing kits to type 2 diabetics. Some kits in market Accu-Chek kit, by Roche Diagnostics India, costs Rs 1,750. Johnson & Johnson's Lifescan OneTouch Ultra costs Rs 2,600 and comes with 10 sensor strips. For 25 additional strips, one has to pay Rs 700. Arkray Piramalís Glucocard costs Rs 1,610. GlucoMen PC from Morepen Laboratories can be hooked to a computer. It costs Rs 5,200 and comes with 25 strips. Ashlesha Kamat, a middle-aged housewife in Mangalore, found she had type 2 diabetes. Kamat's diabetes is mild; diet control and exercise can manage her problems. Yet she uses Accu-Chek blood glucose meter manufactured by Roche Diagnostics India. Kamat's doctor recommended testing at home. She spends around Rs 1,000 a month on them. Blood sugar is measured by pricking the finger and soaking the drop of blood on a test strip. The strip is inserted in a machine and the reading comes on the meter's digital monitor. The blood glucose monitoring system market in India, according to a report in Express Pharma Health Care in 2008, is estimated to be more than Rs 1 billion and expected to grow by around 20% by 2012. In 2008, Journal of Diabetes Research and Clinical Practice published a study by an international group of researchers. It found that, with only 0.2% diabetics using blood glucose testing kits, India was the lowest user. Industry is now doing its best to change this. It is promoting the medical devices with helpline messages that warn, "High blood sugar can affect your eyes, heart and kidneys. Check regularly and live peacefully". But not every diabetic needs to check his or her blood sugar every day. Two independent studies published in the December 2009 issue of the Canadian Medical Association Journal analysed the clinical and cost benefits of glucose testing strips among diabetics. Both studies concluded that, besides patients who are dependent on insulin and those with erratic diabetes (which causes rapid swing in blood sugar levels), the strip has limited ability to significantly change the management and monitoring or treatment of type 2 diabetes. In Ontario, Canada, blood glucose test strips were the third largest cost to the public health programme in 2007 to 2008. In India, the patient pays for the test strips. Doctors though are divided on testing. According to V Mohan, endocrinologist at the Madras Diabetes Research Foundation, "constant surveillance helps to maintain tighter control of blood sugar. Patients with non-insulin-dependent diabetes should also test it twice a week". Shireesh Upadhye, a diabetologist who works among the rural poor in Virar near Mumbai, pointed out "Regular monitoring is not required in any population unless the diabetes presents with recurring complications or is erratic". Even the International Diabetes Federation, in its guidelines released in October 2009, recommended self-monitoring with caution. Strips are prone to wear and tear, chemical degradation and also the calibration, and the user efficiency is vastly subjective. Pathologists caution that blood strips cannot substitute lab tests that provide information on more than just the blood sugar levels. Upadhye provides a caveat, "The pharma companies are marketing in urban setups where labs are available, whereas the need is in rural areas that do not have access to laboratory vigilance mechanisms". Pro-motion oОбувь