Diabetes testing supplies: a how-to selection guide; High-quality blood glucose testing applied appropriately is critical. What to look for.

Frequent monitoring can have an immediate, positive affect on the health of a patient with diabetes. Monitoring is critical in all aspects of diabetes, but never more than in severely compromised patients, such as those commonly found in nursing facilities. Often the blood glucose test provides the most accessible piece of information available to the nursing staff, who is required to make potentially lifesaving decisions based on a number that appears in the display window of a small machine. This puts a premium on accuracy, patient comfort, availability, speed, ease of use, technical integration, and versatility as features important to blood glucose monitors.

Accuracy

Today's technology is so effective that testing results can be extremely accurate. This results from a combination of the quality of the machine, the integration of the blood glucose testing strip with the machine, and the procedures followed by the nursing staff. "Most long-term care facilities have residents on a sliding scale for insulin delivery, and if the instrument isn't accurate, insulin doses will be incorrect and patient outcomes will be compromised," notes Fred Engimann, vice-president of sales for CHdiagnostics.

Many manufacturers of blood glucose monitoring systems have conducted clinical studies to show the accuracy of their machines. A nursing home should research these machines and select one that is accurate to within 5%. These same manufacturers all make strips that are highly accurate when used properly. A system should have an easy-to-use link between the strip and the machine. A computer chip or a calibration strip should be easy to install and be able to easily verify the link or code. Finally, the nursing staff needs to be fully trained. Find a distributor and manufacturer that will train and in-service the entire staff on patient testing, as well as the quality-assurance program. All major manufacturers provide testing methods for ensuring the accuracy of the machine/strip combination, and a good distributor will understand the product well enough to in-service the staff at any time.

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Patient Comfort

Historically, the blood glucose test has been performed by lancing the side of the finger up toward the tip, collecting a small amount of blood, and testing the glucose levels in that sample. It's best not to lance the very tip of the finger, where nerve endings make lancing painful. The amount of blood needed for the test determines how large a lancing device should be used to draw the sample. Many of the high-quality testing systems available today require less than one microliter of blood--less than one-third of what was required just a few years ago. The smaller sample size allows the nursing professional to use a smaller lancet, thus allowing for frequent testing with relatively little pain.

Availability

If the blood glucose testing system is not readily available to staff, it doesn't matter how accurate it is. Work with a distributor that will provide plenty of backup meters at the facility. The distributor should also have the emergency capabilities to deliver supplies quickly.

Speed

Nursing efficiency has become more important as each year passes. The highest quality blood glucose machines will take an accurate glucose reading in 5-10 seconds, which allows the nurse to do an accurate check and still have time to give great patient care.

Ease of Use

This feature goes hand in hand with accuracy and speed. An easy-to-use blood glucose testing system improves the testing environment overall. The system should be easy to calibrate (the linking of the strip to the machine), easy to test (the process of quality testing the machine), easy to use, easy to dispose of the blood sample, and easy to clean.

Technical Integration

Because documentation needs and requirements have increased over the years, some facilities have selected blood glucose testing systems that go beyond everyday testing and have selected a more high-tech approach. Their monitoring machines can provide significant quality-assurance checks, as well as a direct download of information into their computer systems. The Precision PCx[TM] testing system by Abbott Diabetes Care, for example, uses computer technology to protect both the patient and the institution. The Precision PCx machine requires the input of extra information before testing, whereupon the scan strip calibrates the strip to the machine, reads the expiration date, and checks the lot number to ensure a high-quality test from the start. In addition, the patient and the caregiver identification numbers are coded into the machine before testing. If any of this information is missing, the test cannot be performed. The Precision PCx permits all testing data to be downloaded into the computer for analysis and documentation, which provides the end user with better, more detailed information to improve patient care.

Versatility

Recently, alternate-body site testing has become a popular option. Alternate-site testing products test blood drawn from the arm or leg. Although some users claim that alternate-site testing is less painful compared with the more common finger stick, many manufacturers do not recommend alternate-site testing in the nursing home environment. More clinical information is needed about the accuracy of alternate-site blood glucose testing because this is, of course, critical in the long-term care setting.

To find the appropriate blood glucose testing system, contact a supplier that can provide information on several leading systems. Research your technology needs and the features of each system. Be sure that the accuracy of each system is supported by documentation. Determine the amount of blood necessary to perform a test (the less required the better). It is also important to compare the length of time each system requires to perform a test. Evaluate the company's ability to train staff members and keep them abreast of changes in the industry. Finally, do a feature/cost comparison to help determine which system fulfills your facility's specific needs.

Al Wiggs is Sales Manager for Xcel Medical, a medical supply company. For more information, call [phone] or visit www.xcelmed.com. To send your comments to the author and editors, please e-mail [e-mail].

RELATED ARTICLE: Type 2 Diabetes: A Major Concern

Type 2 diabetes accounts for as many as 90% of the reported cases of diabetes and is fairly common in the older population. In the United States, as many as 8.6 million people over the age of 60 have type 2 diabetes. This disease can lead to many secondary health issues, including an increased risk of heart attack and stroke, kidney disease, nerve damage, amputation, and even vision loss if not properly monitored and treated.