We know that the only person who can tell us what to eat and exercise is ourself. But most of us need a third leg of diabetes control — one or more of the prescription drugs — and we usually leave that decision up to our doctor.
Often this is a big mistake. Many of our doctors are too set in their ways. The problem is simply that doctors too are human.
Older doctors have practiced most of their lives with a Hobson’s choice of one oral diabetes drug. In 1957 the first sulfonylureas became available by prescription in the United States. Not until about 40 years later did the Food and Drug Administration approve a second diabetes drug, metformin.
Until we could get metformin, we did have the opportunity to take insulin instead of a sulfonylurea. And we had a lot of different sulfonylureas to choose from, making it appear that our choice was greater that it really was. Brand names include Amaryl, Glucotrol XL, Diaßeta, Glynase, Micronase, as well as Dymelor, Diabinese, Orinase, and Tolinase. Combination drugs like Metaglip, Glucovance, Avandaryl, and Duetact also are part sulfonylurea.
American agriculture changed more in the past 50 years than it did in the previous 10,000 years since humans started cultivating grains and domesticating cattle, pigs, and poultry. This affects all Americans, but none more than those of us who have diabetes, which started its steep rise at about the same time that our farms became so much more efficient under the management of just a few huge multinational corporations.
This correlation certainly isn’t proof that modern agriculture caused the rise of diabetes. It remains, however, a likely suspect.
Neither can we fairly claim that the giant corporations that control most of American agriculture are the cause of anything more than being efficient. These companies are doing what companies are supposed to do — making a lot of money by doing what all companies try to do.
The root of the problem is our government. The federal government of the United States of America set the conditions under which the great consolidation of American agriculture took place. This is our “farm policy.”
When Roche Diabetes Care invited 29 of us who write about diabetes to “Social Media Summit” last week, some of us had the opportunity to visit their factory in Indianapolis that produces Aviva test strips. I toured the factory with Bryan Langford, the director of the product supply team for Roche Diagnostics Operations.
The Accu-Chek Aviva is the only meter and strip combination manufactured in America. Roche makes the Aviva meter in Huntsville, Alabama. Roche built the Indianapolis plant a couple of years before the company launched the Aviva in July 2005.
The other meter that Roche currently markets here is the Accu-Chek Compact Plus. Roche manufactures the test strips for that meter in Germany and manufactures the Accu-Chek Compact Plus meters in Ireland.
The U.S. Food and Drug Administration is finally planning to require that our blood glucose meters will meet high standards of accuracy and precision.
Dr. Margaret Hamburg, the new head of the FDA, recently wrote the American Association of Clinical Endocrinologists, or AACE, that the agency is pressing the International Organization for Standardization, or ISO, to set higher standards of accuracy and precision. “If the ISO standard for accuracy is not revised, the agency…may instead recognize other (higher) performance standards for SMBG [self monitoring blood glucose] devices for management of diabetes,” according to a letter and attachment that she sent to AACE President Dr. Jeffrey Garber, and past presidents Drs. Daniel Duick and Richard Hellman. Dr. Hamburg’s letter was a positive response to a formal request that the AACE made to the FDA in May.
Anyone who has ever tested his or her blood glucose for more than a month or so must be appalled at how inaccurate our blood glucose meters are. In the past ten years or so I must have written a dozen articles pointing out how bad they are.
The FDA didn’t tip its hand yet by putting in writing to the AACE just what new standards it plans to require. But the agency did drop a hint.
About half of the last 31 blood glucose meters that the FDA approved for sale in the U.S. would meet performance standards within 10 mg/dl, when reading should be less than 75 mg/dl, and withing 15 mg/dl, when the reading should be above 75 mg/dl, according to the attachment Dr. Hamburg sent Dr.Garber. The FDA recognizes that when our blood glucose levels are below 75 mg/dl, accuracy becomes even more important.
This morning’s New York Times reported this big news for all of us with diabetes. Even though I subscribe to the print edition, I was out hiking in the Rockies today and haven’t read the paper yet. Thanks to two of my favorite diabetes professionals, Certified Diabetes Educator Karen LaVine and Dr. Richard K. Bernstein, for emailing me the link to that article. This is such good news that I needed to write about it today.
This article is based on an earlier version of my article published by HealthCentral.
The price of blood glucose meters isn’t the problem. But the price of test strips sure can be.
The last time I looked, some of the leading manufacturers were charging us almost $1 per test strip. For those of us who don’t have health insurance and test a lot, that can get expensive pretty quick.
But now one of the most aggressive manufacturers has introduced a meter that uses even less expensive test strips than its previous best. It also has better specs.
The company is US Diagnostics Inc. in New York, N.Y. They call their new meter the Infinity, which I assume they mean to refer to quality and not price.
You may be able to get the meter at no cost, because meter manufacturers mostly work on the “freebie marketing” model where they give away one of their products to generate a continual market for another, generally disposable, item. A guy named King Gillette pioneered this approach to get us to buy his razor blades.