An estimated 2.7 million Australians have diabetes, a condition affecting the way the body processes sugar. This is due to a lack of, or resistance to, a sugar-processing hormone called insulin.

Pathology testing is part of everyday life for people with diabetes, who must monitor glucose levels throughout the day to avoid complications such as heart disease, kidney disease, and blindness.

In serious cases hyperglycaemia (high blood glucose) or hypoglycaemia (low blood glucose) can lead to unconsciousness and even death.

Traditionally blood glucose is monitored via the ‘fingerstick’ method, where a person draws blood from a fingertip and tests a drop using a portable device.

In recent years, Continuous Glucose Monitoring (CGM) technology has emerged and various devices are now available that can be used for all types of diabetes, where needed.

This testing is different as it measures glucose levels in the interstitial fluid just below the skin, usually via a sensor patch worn on the skin that transmits to a small monitoring device. These results can have a time delay of up to an hour when compared to blood glucose levels and therefore people using the devices are encouraged to still use blood testing as part of their management.

Some CGM devices can be connected to an insulin pump. The sensor can be set to a level at which it will stop the pump, when the person’s glucose level is dropping too low and insulin delivery should be halted. At the other end of the spectrum the wearer is warned if their glucose level is high and action is needed. The device does not control insulin delivery, this is still manually controlled.

Tanya Ilkiw works for Diabetes NSW & ACT and is living with Type 1 Diabetes:

“The technology is a useful tool and is particularly helpful for people who are ‘hypo-unaware’; finding it hard to judge when their glucose level is low. Children or newly diagnosed people may be hypo-unaware as they are still learning how to recognise symptoms or are going through changes that affect their glucose levels such as puberty. Some people don’t experience symptoms when their glucose levels drop or may become hypo-unaware when they have lived with diabetes for some time.”

The technology has been developed in part because of the pain and inconvenience of drawing blood for testing, usually 5-6 times a day, which is particularly difficult for children. Prolonged fingerstick testing may also lead to callouses, nerve damage and loss of sensation in the fingertips.

Cheryl Nankivell a Diabetes Educator at Diabetes NSW & ACT said:

“CGM systems can reduce the number of fingersticks needed and also show a continuous picture of how glucose levels are fluctuating. This can identify patterns that may be useful to patients and diabetes management teams.”

Although moving in the right direction, Ms Ilkiw says that more work is needed to understand how the technology can best help patients.

“Sometimes you look for a pattern, it becomes addictive, but there may not be one. Having constant information can increase paranoia about your diabetes and make it harder to get on with life. This is a useful tool for management and is shifting the way we look at the numbers but it still cannot replace finger blood tests completely.”

CGM has proven useful for parents of children with diabetes but may not be right for everyone, said Ms Nankivell:

“We know of a case where a young woman was overseas and her mother triggered an emergency response because she used monitoring technology to see that her daughter’s glucose level was dangerously low. However, it is not one size fits all and may feel like a burden for some. I hope for a system where we no longer need to penetrate the body for diabetes monitoring, but we aren’t there yet.”

People using CGM devices should still have regular HbA1c tests as part of their diabetes management.

The post A benefit and a burden; the diabetes technology dilemma first appeared on Know Pathology Know Healthcare.

The World Health Organization has prioritised the fight against antibiotic resistance due to it’s potential to undermine years of successful drug development. As a result, many diseases now only seen in developing nations may return, such as tuberculosis.

Development of the small device has been funded by the US Defense Department and the Gates Foundation, the charitable foundation of Bill and Melinda Gates. It consists of 16 chambers which contain genetic material from bacteria often resistant to antibiotics. When a ‘match’ is made in the DNA, the chamber lights up to alert the doctor. They can then decide to go the extra mile to obtain the best drug for that infection or quarantine the patient to prevent it from being spread.

It is still early days for the device. The American researchers have created a company to raise more funds to improve the technology so that it may be commercially distributed in the future.

There are a number of causes of antibiotic resistance, but all are related to the inappropriate use of antibiotics.

When a patient presents with a likely bacterial infection doctors will ask pathology staff to identify the bacteria and test it for resistance to antibiotics. This ensures they prescribe a drug that will work well against that specific infection.

In remote areas or regions without adequate healthcare infrastructure this is not always possible, so doctors will prescribe a ‘broad spectrum’ antibiotic. These are antibiotics that can kill a lot of different types of bacteria, but often with results that are adequate without being excellent. Strong bacteria will not be killed by the drug and when they multiply, their offspring will also be able to survive exposure to the medication.

Other causes include the overuse of antibiotics in the farming industry to prevent costly outbreaks in herds or flocks. In a major win for those advocating for action against the problem, the American Food and Drug Administration banned the use of certain antibiotics in domestic hand soaps and detergents in 2016.

A simple cause that you can do something about is following doctor’s orders with regards to taking antibiotics. Always finish the full course of antibiotics as directed by your doctor, even when if you start to feel better partway through.

Here is Know Pathology Know Healthcare Ambassador Professor Peter Collignon discussing the problem of antibiotic resistance. Credit to the Milken Institute School of Public Health at the George Washington University for this video.

The post Mobile antibiotic resistance test could reduce superbugs in warzones first appeared on Know Pathology Know Healthcare.

An Australian initiative has helped so many Indigenous Australians better manage diabetes that it has been adopted by several other countries to deliver better healthcare to their Indigenous populations.

The Quality Assurance for Aboriginal and Torres Strait Islander Medical Services (QAAMS) Program addresses the spiraling rate of diabetes among Indigenous Australians.

The rate of diabetes is three to four times higher among this group than the general Australian population. Indigenous Australians also have higher rates of related deaths and complications such as kidney disease and limb amputations.

The QAAMS Program provides on-the-spot blood testing for diabetes. The tests are completed by trained Aboriginal Health Workers using a small, portable device that tests the patient’s level of haemoglobin A1c (HbA1c).

This test can be used to diagnose and monitor the condition. Lower results reflect better controlled diabetes.

Results are returned to the patient within minutes of sample collection. This eliminates the need for travel back to the clinic to collect results for patients who live far from testing laboratories.

A 2014 study in remote Australia found 40 diabetes patients whose HbA1c had dropped more than 1.5% across 15 months since their health services joined QAAMS. Prior to QAAMS the patients had not shown any reduction in their HbA1c.1

To place this in context, a drop of just 1% in HbA1c over five years reduces the patient’s risk of diabetes-related limb amputation by 21%.2

QAAMS began in 1999 with 45 participating Aboriginal medical services. After 17 years of federal funding, the program has overseen the training of more than 1,500 Aboriginal Health Workers and nurses across 200 sites.

Aboriginal Health Workers are central to the program’s enduring success. They ensure that the entire process is performed with scientific accuracy and in a culturally safe manner.

Professor Mark Shepherd manages the QAAMS Program. He says,

“Point-of-care diabetes technology was in its infancy when this program began. QAAMS has shown that, when used with appropriate training, point-of-care testing can significantly help to improve diabetes control in Indigenous populations.”

The group recently received a coveted Projects That Work award from FAIMER International. QAAMS was recognised as one of the top five projects globally out of a field of 100 nominations.

Communities in seven other countries have adopted the QAAMS model in their approach to Indigenous diabetes care; these are South Africa, Canada, East Timor, Papua New Guinea, Western Samoa, the Solomon Islands and Thailand.

Reference:

1. Spaeth BA, Shephard MDS, Schatz S, Point-of-care testing for haemoglobin A1c in remote Australian Indigenous communities improves timeliness of diabetes care. Rural and Remote Health 14: 2849. (Online) 2014
2. The Economic Value of Pathology, CIE & PAA 2016

The post Closing the gap on diabetes one test at a time first appeared on Know Pathology Know Healthcare.

A 2014 report from the Australian Institute of Health Welfare estimated that a third of Australians live outside the major cities and noted that mortality rates and rates of preventable hospitalisations increase with remoteness.

Luckily, Australian pathology is committed to making testing readily accessible to all patients through point of care testing – medical tests near the patient.

A major benefit of point of care testing (POCT) is improving access to testing in rural and remote healthcare.

POCT provides immediate access to test results that might otherwise have been hours or even days away for samples to be transported to a lab. This immediacy to medical indications allows patients who may have previously been “medevaced” (transported to receive urgent medical attention) to receive local care. This can avoid the distress of relocation and it reduces patient drop-off by generating instant results especially helpful in the management of chronic conditions.

A/Prof Bruce Chater, Head of Rural and Remote Medicine at University of Queensland, is very clear on the huge impact point of care testing has had on this area of medicine;

“Bedside pathology and other technologies are revolutionising rural practice. The ability to diagnose a heart attack, monitor medication, check salts and kidney function and check the blood gases in a seriously ill patient means that rural generalists can make more informed decisions when they need to be made – here and now.”

One example is the use of the i-STAT in Queensland. This handheld blood analyser uses single use test cartridges, meaning the device can be used for a broad range of the most commonly performed tests including cardiac markers, coagulation, blood gases, chemistries and electrolytes, and haematology.

The Pathology Queensland i-STAT network is the largest in geographical size in the world – the network covers the entire state from the Sabai islands in the north to Stanthorpe in the south. Within minutes of a sample being taken the results are available on the state-wide database.

To ensure results are accurate equipment is tested daily and all staff receive comprehensive training. Results are reviewed by medical scientists and unexpected results are followed up further. The network also takes part in the quality program run by the Royal College of Pathologists of Australasia.

The entire network is managed centrally from Brisbane, meaning that even the most geographically isolated of health clinics are fully supported.

Amongst Aboriginal and Islander patients in Cape York and the Torres Strait, rheumatic heart disease is a significant health problem. Treatment requires anticoagulant medication that must be closely monitored. Before the introduction of the i-STAT, samples for monitoring would have to be sent from outlying islands to Cairns. In summer, samples did not always survive the trip but point of care testing has overcome this problem.

Last year the Pathology Queensland i-STAT network performed over a quarter of a million patient episodes. Access to pathology services for all Australians, wherever they live, is just one of the many reasons why Australian pathology is world-class.

The post Small in size, big in scope: Point of care testing in rural and remote Queensland first appeared on Know Pathology Know Healthcare.