Now that is cool: Testing your sugar without needles and without blood droplets.
In Europe, the medical company Abbott has just released its FreeStyle Libre system, which may usher in a revolution in diabetes care. And both doctors and patients can’t wait.
Prabahar Gopalakrishnan, 26, is a type 1 diabetic who has taken daily insulin injections since the age of seven. “I’ve probably pricked my fingers almost 15,000 times so far,” he tells me.
Chandroutie Permaul, a 65-year-old woman with type 2 diabetes, also finds routine self-testing problematic. “My flesh gets so tender,” she complains. “And when I wash the dishes, it just burns and burns.”
These hassles may soon be a thing of the past.
The Libre system uses an advanced, coin-size sensor that is worn on the arm for two weeks at a time. According to the instructions, a tiny “filament is inserted just under the skin and held in place with a small adhesive pad.”
It comes with a hand-held scanner which looks like a largish smartphone. Swiping the scanner over the sensor instantly measures your sugar, displaying the result in “less than one second.”
Speaking at the European launch in Vienna, Jared Watkin, a technology vice-president at Abbott, also demonstrated that you can even scan the sensor “through your clothes.” You don’t even need to calibrate the system with a test drop of blood.
That’s remarkable – and unheard of in the diabetes world.
“Patients would fly with this,” says Dr. Susan Burlacoff, a Toronto family physician. She believes there will be great utility of this bloodless system in her own practice. “It’s painless, convenient, without needles and [patients] wouldn’t have to worry about getting blood on their clothing or papers or food.”
Since the technology is digital, the sensor is always on – 24/7 – always measuring sugar. Known as continuous glucose measurement (CGM), this is usually done at the research level, where precise recordings are required.
But with this new sensor, such precision goes retail: Regular patients can benefit from this constant sugar surveillance. In fact, the measurements are so detailed that the graphs look like fluctuating, moment-to-moment stock-market prices. This is known as Ambulatory Glucose Profiling (AGP). What’s more, patients can be forewarned if their levels go too low or high; and they can view their trendlines over the last hour, day, week or even months.
Notably, the Libre device will even generate the single key number that doctors are after – the three-month sugar, known as the hemoglobin A1c. It is this number, how your sugar has done over the past three months, that doctors track to predict the complications of diabetes, which include eye, heart, kidney and nerve disease. In fact, it is this number that guides therapy, tells us if our patients are controlling their sugar or if we have to bump up the number of pills or prescribe insulin.
Until now, the only way to know the hemoglobin A1c, this important predictive measure, was to go to a medical laboratory, present your arm for a blood test by vein puncture and then wait to see your doctor for the results. Now you can get the number at home and even e-mail it to your physician.
Dr. Hamid Gilani of Guelph, Ont., senses that arming patients with such detailed information will inspire people to take better care of themselves. Missed your medication? Had too much dessert? Didn’t walk off that evening meal? The effects of all these (mis)behaviours can be seen as they evolve. “Knowing glucose levels in real-time will help patients balance their day-to-day medications, exercise levels and food intake,” he says. “I’m looking forward to trying [the system] out.”
The Libre system is not available in Canada. Health Canada spokesman Eric Morrissette said the federal department is unable to “disclose or acknowledge the receipt of a drug or medical device application,” considering this “proprietary information.”
But as a doctor who knows what patients go through, I hope the application has been filed and that approval for the device comes soon. To stave off the devastating complications of diabetes, our three million diabetic patients need all the help, empowerment and self-knowledge that they can get.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging. Dr. Shafiq Qaadri, MPP, is a Toronto family physician, Continuing Medical Education (CME) lecturer andmedical writer. His first novel, a medical thriller, is BioJihad & the Pleasure-5 Surgery.
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