ALPHA-385/R1 May 2010 © Abbott Laboratories Striving For Better Patient Outcomes Improving the Diagnosis and Monitoring of Diabetes.

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

ALPHA-385/R1 May 2010 © Abbott Laboratories Striving For Better Patient Outcomes Improving the Diagnosis and Monitoring of Diabetes.

Documents

monitoring of diabetes

abbott laboratories

glucose monitoring

early diagnosis of diabetes

review of diabetes

early detection of diabetes

earlier diagnosis of

insulin cats