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328 Cardio Diabetes Medicine 2017

Monitoring in Diabetes

Dr. Kevin Shotliff, UK

Consultant Physician, Diabetes and Endocrinology
Beta Cell Diabetes Centre
Chelsea and Westminster Hospital
London

Abstract: a test tube, then moving onto reagent strips which
st
The use of self-monitoring methods by people with are compared to a colour coded strip. The 1 com-
diabetes to help improve overall glycaemic control, mercially available method being the Ames ‘Clinitest’
and in particular help reduce the day-to-day variabil- launched in 1941, which used tablets added to urine
ity in glucose levels they experience, has progressed in a test tube, giving a chemical reaction and a co-
through many modalities, starting with urine test- lour change depending on the glucose content of the
ing, then capillary blood glucose testing, and more urine. By 1954 Eli Lilly and Beohringer Manheim has
recently the use of continuous glucose monitoring launched Glucotest and the Testape roll, which were
systems (CGMS), and is likely to progress further as testing strips which were put into urine, with a colour
technology advances. change compared visually to a chart to determine the
glucose level, before the more familiar Dipstix such
Text: as Diastix and Clinistix became regularly used in the
1960’s.
It is now well accepted that the longer a person with
diabetes is exposed to high blood glucose levels, This monitoring method relies on blood and renal
the great potential there is for them to develop both filtrate glucose levels exceeding the renal threshold
macrovascular and microvascular complications, as for resorption, typically around 10 mmol/L, but this
well as more acute metabolic issues from the elevat- threshold can vary both between individuals, and
ed blood glucose. The use of glycated haemoglobin also in the same individual over time, so is not ide-
/ HbA1c measurements as a measure of glycaemic al. It also gives an average of glucose levels for the
control over the preceding 2 to 3 months, with the time urine accumulates in the bladder, rather than
month prior to the sample taken being particularly the absolute value at a particular point in time, but
important in that value, is also well accepted and is much better than the historical method of tasting
standard practice, with individualised targets for urine for its sweetness.
HbA1c levels in different patient groups ‘now been Blood glucose measurements, initially with
normal practice. This more intermediate term mea- strips,again being compared to colour changes on
sure however, gives an overview of glycaemic con- a chart, often on the side of the container used to
trol, but not an idea of day to day variability. store the strips, started to be available from the mid
Self-monitoring by the person with diabetes of their 1960s, but were not really used for self monitoring
glycaemic control is one way to try and assess this until the late 1970’s and the first, more regular use
day to day variability, in more detail,and again is not of a self monitoring system, rather than a hospital
a new concept. Ideally access to this self-monitoring based system, with a meter, was in the 1980’s, with
data allows an individual to adjust their diet exercise the first Roche Reflolux / Accu-chek meter available
and glucose lowering therapy enough to achieve bet- in 1983. By the late 1980’s second generation meters
ter overall blood glucose control, so reducing the po- were available, and by the early 1990’s strips which
tential for hypoglycaemia associated complications. allowed capillary blood to be drawn into a gap be-
tween two plastic layers of a test strip, nearer to the
Home urine glucose measurements have been used technology we take for granted now, started to be-
for many years, initially using a chemical reaction in

GCDC 2017