Wednesday, January 4, 2012

A guide to not faking your glucose result

Faking glucose test results has always been around and I have never understood why this occurs. I recently read somewhere ( I just cannot find the article ) that about 30 % of people with diabetes provide their doctor with inaccurate data.
  The rate of adherence with complex diabetes regimens is only 67 % and less than 11% of people with diabetes achieve  the recommended target goals for A1c, LDL cholesterol and blood pressure. Providing your health care provider with inaccurate information is just an interesting sidelight to why the current programs are not as successful as they could be. Diabetes office visit book, ebook , iPhone  and iPad app simplifies the approach to diabetes care  ( Fixing The Nine ) and may be a step in the direction of improving diabetes care.  See yesterdays blog.
American Diabetes Association. Diabetes statistics: data from the 2011 national diabetes fact sheet. Accessed September 15, 2011
I was most aware of the faking glucose problem in teenagers , struggling with a complex disease interfering with their lives multiple times  each day . I  also discovered that diabetes educators were better at recognizing this problem than I was . Our ability to discover this problem has improved with better technology.  Faking glucose rest result does not work and it is not in your best interest. If you feel the need to try this behavior , don’t do it .  Think about who will suffer the consequences of this decision , you. I suggest you use this as an opportunity to talk with your doctor about some of the real issues effecting your ability to manage this disease. You will both benefit from the discussion. 
Initially we relied on subtle hints such as all of their data ending in a common number ,like 0 or 5.  The newer glucose meters that store data is a big help but can be time consuming. I will review some of the new technology that make the idea of faking glucose data more difficult and allows health care provider better deal with the issues leading to this type of behavior.
 On site A1c testing . These test are accurate and provide results  to the doctor in about 5 minutes. The  A1c test provides an understanding of the average blood glucose over the past 60-90 days.
Glycated albumin (fructosamine), which provides an understanding of the average blood glucose over the past 2 weeks.
1,5-anhydroglucitol (1,5-AG), provides an understanding of the average blood glucose over the past day, as well as a measure of glycemic variability.This test is decreased by hyperglycemia but not increased by hypoglycemia, a low level of 1,5-AG in the presence of normal or near-normal A1c hemoglobin indicates increased glycemic variability. Example ; averaging  glucose results of 250 mg/dl and 50 equals an average glucose of 145 and an A1c of < 7
Continuous glucose monitors are worn by the patient and provide information on patterns of blood glucose control, including glycemic variability.
Different ways of monitoring your glucose control are valuable tools in our pursuit of excellence in diabetes care. The use of these tools will help us gain more understanding of some of the difficult issues our patients deal with each day. 
There are clinical standards for the performance of A1c and SMBG testing but there are no standards for the other tests.

  Have fun, be smart , and defeat diabetes.       
                                    David Calder , MD

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Your comments and questions are appreciated. David Calder,MD