Importance of Pattern Management for Glycemic Control: The OneTouch VerioIQ Meter

The American Journal of Pharmacy Benefits, September/October 2012, Volume 4, Issue 5

The OneTouch VerioIQ Meter uses pattern recognition technology for self-monitoring of blood glucose, a key part of treatment management in patients with type 1 and type 2 diabetes.

Diabetes is a chronic metabolic illness requiring continuous self-management and medical care to avoid acute medical events and reduce the likelihood of long-term complications. Studies have demonstrated the importance of maintaining stable glycemic control to prevent the short- and long-term complications of diabetes, resulting in significant clinical1,2 and economic benefi t.3-5 Approaches for achieving glycemic control vary and include lifestyle modifications (ie, changes in diet and physical activity), oral medications, and/or an insulin regimen. Because diabetes is a progressive disease, intensification of management with oral medications and insulin is often required.6,7 Unfortunately, given the importance of achieving glyemic control, only about 50% of patients with diabetes are achieving glycated hemoglobin (A1C) goals (<7%).8

Self-monitoring of blood glucose (SMBG) is a key part of treatment management in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM, respectively). It is an important tool to aid in prevention of the potentially serious consequences of very high or very low blood glucose levels.9 SMBG allows patients with diabetes to determine the daily effects of lifestyle and pharmacologic interventions on their glycemic control, and subsequently take appropriate action. It is one of the main methods for providing immediate information between clinical visits about how a patient is doing with respect to glycemic control and it can ultimately lead them to make improved lifestyle decisions.10,11 The American Diabetes Association suggests that more than 50% of cases of hypoglycemia can be predicted based on risk analysis of SMBG values.12,13

While SMBG is an important tool to collect data on blood glucose values, it is only through processing and analyzing the collected information that these data can become actionable knowledge.11 Pattern management involves the systematic interpretation of SMBG data over time, which helps identify the need for changes (eg, adjustments to insulin dose, carbohydrate intake, and/or physical activity) to achieve optimal glycemic control.14 Pattern management enables patients with T1DM and T2DM using insulin to assume more responsibility for their diabetes management and it often leads to improved glycemic control by limiting the magnitude and duration of glycemic excursions. While the importance and value of pattern management has been established, one of the ongoing difficulties is engaging patients in its use.15,16 Patients can review data with their clinicians during visits or they may react to blood glucose readings in the moment with increased carbohydrate intake or an insulin bolus; however, they are generally not making changes to treatment decisions based on pattern recognition.14,17 Real-time pattern recognition may better inform clinicians and patients on what actions to take, such as therapy adjustments, thereby decreasing the risk of recurrent hypoglycemia and increasing the ability to maintain glycemic control.14,18

Figure 1

provides an overview of how the intensifi cation of treatment, recurrence of hypoglycemia, and hypoglycemia unawareness can become a barrier to achieving glycemic control goals. If patients are empowered to recognize these patterns of hypoglycemia, it may be possible to make changes and avoid more severe hypoglycemia.1,19-22

The OneTouch VerioIQ Meter (

Figure 2

) may help address this need through its PatternAlert Technology, which looks for patterns of highs and lows and alerts patients right on-screen, so they can know when to adjust their insulin, antidiabetic medication, meal, or exercise regimen. The OneTouch VerioIQ Meter is the fi rst meter with this functionality. The PatternAlert Technology was developed in accordance with current applicable international guidelines and advice from key opinion leaders. The International Diabetes Center (IDC) suggests that 2 low blood glucose readings on consecutive days at the same time of day constitute a pattern of low blood glucose readings. Similarly, the IDC states that 3 high blood glucose readings on consecutive days at the same time of day constitute a pattern of high blood glucose readings.14,23

The PatternAlert Technology seeks low blood glucose patterns based on low blood glucose readings on 2 out of 5 consecutive days within a 3-hour time period and seeks pre-meal high blood glucose patterns based on high blood glucose readings on 3 out of 5 consecutive days within a 3-hour time period. When a pattern of low or pre-meal high blood glucose is detected, the meter displays an onscreen message with details (eg, dates, times, blood glucose values, and meal tags) of the blood glucose readings that resulted in this particular alert.24

Figures 3

and 4 provide examples of a detected low and pre-meal high blood

glucose pattern along with the on-screen messages that would be received on the OneTouch VerioIQ Meter.

A retrospective analysis of blood glucose data from 2 trials that used blood glucose meter downloads assessed the likelihood of severe hypoglycemia occurring within 24 hours after a Pattern-Alert message would have been triggered. Results showed that the likelihood of suffering a severe hypoglycemic event within the next 24 hours was double compared with baseline. The authors concluded that the PatternAlert algorithm on the OneTouch VerioIQ Meter has the potential to help patients improve their management of diabetes and could assist them in efforts to avoid hypoglycemia events.25

SUMMARY

The OneTouch VerioIQ Meter is the fi rst and only meter with PatternAlert Technology which looks for patterns of highs and lows and alerts patients right on-screen. The innovative PatternAlert Technology feature was designed to increase a patient’s awareness of high and low blood glucose patterns, so that they know when to make adjustments to insulin doses, carbohydrate intake, and physical activity. In addition, the OneTouch VerioIQ Meter is easy to learn, and it’s easier for patients to fi nd patterns with the OneTouch VerioIQ Meter than with a paper log book. Pattern management enables patients to take a more active role in patient-centered team care and diabetes management. It often leads to improved glycemic control by limiting the magnitude and duration of glycemic excursions.18