ALPHA-385/R1 May 2010 © Abbott Laboratories Striving For Better Patient Outcomes Improving the...

ALPHA-385/R1 May 2010 © Abbott Laboratories

Striving For Better Patient Outcomes

Improving the Diagnosis and Monitoring of Diabetes

ALPHA-385/R1 May 2010 ©2010 Abbott Laboratories2

Objectives

Improve the early detection of diabetes

Increase the quality and impact of patient monitoring

Understand the benefits of home monitoring


Review of Diabetes

• What is diabetes?

– Diabetes is a disease in which the body doesn't produce or properly use insulin, which results in a poor regulation of glucose metabolism

• How does insulin work?

– It enables glucose to enter cells where it is used for energy.

– If your body doesn’t make enough or can’t use its own insulin, glucose accumulates in the blood, resulting in hyperglycemia.

• Hyperglycemia

– Can lead to various complications that compromise a pet’s health e.g., Ketoacidosis, Cataracts, Neuropathy, etc

• What diabetes is NOT? This is important …..

– Diabetes is NOT the outward symptoms, i.e. excessive urination, drinking or hunger etc.

• A patient can be asymptomatic and still in a diabetic hyperglycemic state that if not managed leads to life threatening diseases.

EC Feldman, RW Nelson. Canine and Feline Endocrinology and Reproduction, Elsevier Science, 2004: pages: 486-615.

XS Lwcin, Dogs, Diet and Disease, An Owner’s Guide to Diabetes Mellitus, Pancreatitis, Cushing’s Disease, & More. Lantern Publications 2001.


Two Types of Diabetes Mellitus

EC Feldman, RW Nelson. Canine and Feline Endocrinology and Reproduction, Elsevier Science, 2004: pages: 486-615.

XS Lwcin, Dogs, Diet and Disease, An Owner’s Guide to Diabetes Mellitus, Pancreatitis, Cushing’s Disease, & More. Lantern Publications 2001.

• Known as non-insulin dependent diabetes mellitus (NIDDM).

• Cells fail to use insulin properly, sometimes combined with absolute insulin deficiency.

• May require oral medications or insulin

• Cats most commonly suffer from Type 2

– Remission is possible if:

• Diagnosed early

• Maintain tight glycemic control

• Known as insulin dependent diabetes mellitus (IDDM)

• Caused by destruction of the beta cells

– Insufficient functioning beta cells cannot produce the necessary levels of insulin

• Requires life-long insulin therapy

• Dogs most commonly suffer from Type 1

Type 1 Type 2


• Diabetes is usually noticed when pets become symptomatic :

• Excessive urination, drinking, hunger

• Weight loss

• Fatigue and/or weakness

• Cloudy eyes (dogs)

• Does not groom (cats)

• BUT…some of these pets were diabetic long before the signs were noticed

• Routine, accurate glucose testing would leads earlier diagnosis of diabetes

Why Is Early Diagnosis of Diabetes Missed?

Diabetes: Persistent Hyperglycemia


Why Is Early Diagnosis Important?

• Pet Health:

– Diabetes can be a contributing factor leading to serious complications:• Ketoacidosis

• Neuropathy (nerve damage)

• Increased incidence of infections (especially Urinary Tract Infection)

• Cataracts (dogs)

• Gastroenteritis

– Remission is possible with early detection and tight glycemic control in cats

– Possibly increase the life expectancy of the pet

• Owner Satisfaction:

– Reduce costs associated with an undiagnosed pet; such as, ER visits

– Healthier pet = happier client


Improved Early Diagnosis

Understand and actively look for the Risk FactorsDogs

• Age

– Middle-aged to older dogs are more susceptible

• Unspayed females

• Genetics

• Obesity

• Breed Type*– Australian Terrier

– Fox Terrier

– Cairn Terrier

– Yorkshire Terrier

– Standard Schnauzer

– Lhasa

Cats

• Age

– Older cats are more susceptible

• Neutered Males

• Genetics

• Obesity

• Physical inactivity

• Indoor Lifestyle

• Other diseases, e.g., chronic pancreatitis or hyperthyroidism

- Miniature Schnauzer

- Bichon

- Frise

- Spitz

- Miniature & Toy Poodle

- Samoyed

- Apso

Time Trends and Risk Factors for Diabet es Mellitus in Dogs: Analysis of Veterinary Medical Data Base Records (1970–1999) L. Guptill a, L. Glickmanb and N. Glickmanc The Veterinary Journal, Volume 165, Issue 3, May 2003, Pages 240-247

*Could your dog or cat be living with diabetes – Common signs and risk factors – Intervet Schering Plough / AAHA Pamphlet.


Diabetes Management - Monitoring

• Monitoring is the process of tracking the patient’s glucose level over time – Assesses the effectiveness of the prescribed treatment

– Enables changes to be made to optimize treatment

– Balances the appropriate level of insulin necessary

• Monitoring options:

– Fructosamine

– Urine Glucose

– Blood Glucose

Effective monitoring gives the practice better quality and more frequent information to assess / optimize treatment


How Do We Improve Treatment?

Glucose Monitoring

– Improve the accuracy of monitoring

– Increase the frequency of monitoring

Monitoring Accuracy and Frequency improves the ability to

optimize treatment decisions


Current Blood Glucose Testing Attributes

Attribute

Fast Hours-day Minutes Seconds Seconds

Easy to Use Prep Time Prep Time Simple Simple

Inexpensive $7 - $20 $3 - $7 $0.5 - $1 $1

Accurate Gold StandardAccurate for

dog/catsAccurate for

dogs/catsAccurate for

dogs/cats

Preferred Attibutes in the Veterinary Practice

Reference Lab In-Clinic Analyzer Human Meters AlphaTRAK

AlphaTRAK is the only method that has ALL 4 attributes


Why Are Human Meters Not Accurate?

• Hand-held Glucose Meters work by:– Reading the whole blood sample

– Extrapolating the plasma concentration from the whole blood sample using the ratio of plasma and red blood cells

• Ratios of glucose in plasma and whole blood is species specific

Meters calibrated for humans are not accurate for animals - Plasma and RBC ratios are different


Testing - Accuracy

The AlphaTRAK Validation Study


Testing - Accuracy


Testing - Frequency

IMPACT CLINIC OWNER PATIENT

Late detection of changes in patient status X X X

Inability to detect dangerous hypoglycemia X X X

Time spent outside normal glucose range X X X

Late detection of diabetic remission X X X

Late detection of insulin resistance X X X

Potential for faster onset of long-term effects X X X

Less client involvement/satisfaction X X

Lost clinic revenue X

What are the negative impacts of infrequent monitoring?


Fact or Fiction:

It is technically too difficult for pet owners to generate a blood glucose curve at home.

Blood Glucose Monitoring – Pet Owners

“In this retrospective study, all owners were able to generate a blood glucose curve at home. A previous study conducted in healthy pets showed that 7/7 owners and 3/7 cat owners were able to generate a

reliable blood glucose curve (10). Another recent study demonstrated that 10/12 owners of diabetic dogs were able to perform blood glucose curves at home (22). Good owner communication and education were essential

in obtaining these results (10,22).” Pg. 721

FICTION

Reference:Beyond Insulin Therapy: Achieving Optimal Control in Diabetic Dogs Centre forCompanion Animal Health Copyright 2010 http://www.uq.edu.au/index.html?page=43392&pid=43392Linda M. Fleeman and Jacquie Rand Pg. 2


AlphaTRAK Blood Glucose Monitoring System

Accurate Results Species specific = calibrated for dogs and cats

Small Sample Size

Capillary sampling … no venous draw

Easy-to-Use

Simple 3 step operation

Fast Results

Less than 15 seconds … immediate results

Cost Effective Approximately $1 per test


How to Improve Your Diabetic Program

• Take non-accurate human specific meters out of circulation

• Make access easy

– One AlphaTRAK meter per exam room

– Have an AlphaTRAK Home Monitoring Kit on hand for clients

• Ensure everyone is trained to:

– Use the meter successfully

– Easily obtain a capillary sample

• Develop a Diabetic treatment protocol

– Helps staff recognize proper treatment and follow-up care

– Sets expectations for the client of on-going care scheduling and costs

– Staff can uncover client compliance issues

• Implement a home blood glucose monitoring program


Blood Glucose Home Monitoring Program

• Clinic Preparation: create a client education/support team

– Assign specific staff as the “experts” in home monitoring

– Show confidence in the pet owner’s ability to monitor at home

– Set and communicate proper expectations

• Understand the learning curve and protocols to help clients be successful

• Getting the Client Started: make it simple for the pet owner

– How-to demonstrations & training:

• Capillary blood samples, AlphaTRAK meter operation, insulin administration, nutrition, protocols, etc.

– Set the clients expectations of early challenges that will improve with experience

– Provide a written treatment plan

• Pet specific instructions for hypo/hyperglycemic scenarios

• Include: glucose testing, treatment schedules, other medications, dietary changes, and exercise recommendations

– Establish an ongoing clinic recheck schedule


Blood Glucose Home Monitoring Program

• On-Going Support:

– Set up a call back system to check in on diabetic pet owners

– Share success stories of other client’s successfully managing diabetic pets

– In-clinic client education programs

– Nutrition and exercise consults

An Engaged Client = A Compliant Client


Kit ContentsIncludes what your clients needs to

start home monitoring.

Training:

Accurate Testing Supplies:

Ease-of-Use:

Engagement:

AlphaTRAK Blood Glucose Monitoring System

Features and Benefits

Accurate ResultsSpecies specific = calibrated for dogs & cats

Small Sample Size Capillary sampling

Easy-to-Use

Simple 3 step operation

Fast Results

Less than 15 seconds … immediate results

Cost Effective Approximately $1 per test

Instructional DVD

AlphaTRAK Meter AlphaTRAK Strips (50)*

Lancing DeviceAlphaTRAK Lancets

Quick Users Guide

Pet Diary – Track Readings


Objectives Check

Improve early detection of diabetes

Increase the quality of patient monitoring & management

Understand the benefits of home monitoring

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