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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

The Ultimate Meter

April 10th, 2008 · 2 Comments

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The new WaveSense Jazz meter is by far the best blood glucose meter I’ve ever used.

For years I have complained about the lack of accuracy of other meters. All the other meters also make it too difficult to tag our results to correspond with our meals, and most other meters still require that we code them to match a new vial of test strips. This new meter even includes two ways to calculate glycemic variability, which many people see as even more valuable than the A1C test. And much more.

The U.S. Food and Drug Administration approved the WaveSense Jazz in September. But this jazzy new meter does have one problem. It’s not for sale yet.

The company that makes the meter, AgaMatrix Inc. in Salem, New Hampshire, sent me one of the first Jazz meters off the production line. It came with a bunch of test strips that I have been using. But I didn’t even get a manual or the rest of the kit that we usually get with our new meters, because they aren’t ready yet.

The company expects to have the Jazz on the market here in late summer or early fall, Stuart Blitz, AgaMatrix’s senior manager for marketing told me.

When it’s available, the Jazz will again raise the bar on accuracy. Until now, the WaveSense KeyNote was the most accurate meter with 85 percent of test results within 10 percent — far and away better than any other meter. Now, for the Jazz, Stuart tells me that 91 percent of the results are within 10 percent.

While accuracy is a basic essential, the ability of the Jazz to determine our glycemic variability is a cutting edge refinement that I wasn’t expecting. Some experts are beginning to argue that it’s more important for us to measure our glycemic variability than our A1C. The A1C is an average that can hide wide variations in our blood glucose levels.

The Jazz meter will let you chose to measure your glycemic variability in two different ways. Stuart explained them to me.

“The first way is standard deviation within mealtimes, before and after,” he told me. With the Jazz this is easy and another big step forward in meter design. But entering the correct time slot in terms of mealtime with any other meter is either a pain (requiring you to select from a number of choices in a menu) or impossible. The Jazz uses predictive mealtime tagging. For example, with the Jazz, if you are testing at 1 p.m., it will bring up “post-lunch.” That will usually be correct, and you don’t have to do anything. But if in fact you haven’t had lunch yet, you just click on the up arrow, which will give you the “lunch” slot (press the up arrow one more time, and you will slot it to “post-breakfast).”

“The second way — and it is not in the product that you have right now, because we are just finishing up the implementation — is putting MAGE — the mean amplitude of glucose excursions — into the meter,” Stuart continued. “MAGE measures the amplitude of the readings that you have that are outside of plus or minus one standard deviation from your mean. If you have a smaller MAGE, you are staying in tighter control. Dr. Barry Ginsberg, who was well known as Becton Dickinson’s medical director until he retired last year, pushed for it. He is on our medical board and was the big proponent of adding MAGE.”

Stuart admits that we don’t have any consensus yet on the best way to measure glycemic variability. “But once there is a consensus in the industry,” he says, “the next version of the Jazz will have it.”

The Jazz meter isn’t the first device to incorporate glycemic variability. The Accu-Chek Smart Pix Device Reader — which is pretty expensive, listing for $125 — works with other Accu-Chek meters to calculate it.

Both the Jazz and the Smart Pix use two ways to calculate glycemic variability. While both use standard deviation, the Smart Pix incorporates the low blood glucose index and the high blood glucose index that Dr. Boris Kovatchev, associate director of the University of Virginia Center for Biomathematical Technology, developed. But Peter Blasberg, who developed the Smart Pix for Roche Diabetes Care in Mannheim, Germany, surprised me when he said that the Kovatchev’s indices are “not a measure of glycemic variability.”

The list of advances in the Jazz meter seems to go on and on. A thoughtful touch is the notch on each test strip that insures you are inserting it correctly. I like the confidence that it gives me that I’m putting it in the right way.

This version of the Jazz meter uses a USB port to connect to the AgaMatrix Zero-Click software for automatic downloads to your meter. But the company is making a separate version of the Jazz that will include Bluetooth wireless capability.

“With the Bluetooth version the meter will automatically sync up with your computer,” Stuart told me. He says that the Bluetooth version of the Jazz will be available by the end of the year. Both Stuart and I think that when this version of the Jazz meter comes out, it will be the first one to incorporate Bluetooth.

Also new to blood glucose meters, Stuart and I both think, is the positive feedback that it gives you if your readings are within your pre and post-meal ranges. You can set these ranges yourself.

Even more. “We have the world’s largest digits on a back-lit meter,” Stuart says. It also stores almost 2,000 readings; only the LifeScan Ultra Smart meter will store more.

All AgaMatrix meters, including the company’s earlier KeyNote and Liberty, take a very small blood sample and do it quickly. They take just 0.5 microliters of blood and return the result in just 4 seconds.

While blood glucose meters are generally becoming a commodity, the WaveSense Jazz stands further in front of the crowd than even the earlier AgaMatrix meters did. Commodity meters mean few features, cheaply implemented.

The WaveSense Jazz, on the other hand, has a ton of features and will probably not be cheap. Stuart correctly calls it “a premium product,” and it will probably command a premium price, which the company hasn’t set yet. When it does come to market, Stuart expects that it will be available both in retail outlets and directly through AgaMatrix.

Never before have I written such a glowing product review. This leaves me with nothing more to complain about when writing about blood glucose meters. So I need to make it clear that I have no financial relationship with AgaMatrix — I have no conflict of interest to declare.

Maybe some day we will have a cure for diabetes. That’s when I plan to retire. But for the foreseeable future, controlling our diabetes is the next best thing. And this new Jazz meter offers us a huge step forward in that essential control.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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