Telcare debuts cellular-enabled blood glucose meter at AADE annual meeting

Telcare's cellular-enabled blood glucose meter will automatically upload a user's test results to an online portal.

Though people with diabetes are urged to keep logbooks or to frequently download their blood glucose meter data, life often gets in the way. Fortunately, new innovations are making it faster, simpler, and more useful than ever to keep track of diabetes data. Soon we’ll start seeing smarter and sleeker meters with more connectivity, more powerful data and trend analysis, and improved communication capabilities with doctors and nurses. One encouraging example comes from a small company, Telcare, which debuted its new cellular-enabled blood glucose meter at the American Association of Diabetes Educators (AADE) annual meeting in August. Although the meter won’t launch until later this year, the company’s AADE booth – which included hands-on demonstrations – generated considerable buzz.

The most exciting feature of this new meter is its 3G wireless connectivity (similar to a cell phone), which allows it to automatically upload a user’s test result to an online portal. The process works as follows: 1) someone tests his or her blood sugar; 2) after six seconds, the test result is displayed in large font; 3) a 20 second countdown timer is initiated during which the user has the option to mark the blood sugar reading one of thirteen “reading tags” such as “before breakfast” or “after activity”; 4) once the timer reaches zero or a reading tag is selected (whichever comes first), the test result is automatically sent to MyTelcare.com, an online portal where people with diabetes and those they authorize (e.g., family, doctors, nurses, educators) can log in, view reports and statistics, and recognize trends. The data upload occurs automatically from the meter itself and requires no additional hardware, wires, or service fees. If a user is somewhere out of a cellular service zone, the blood glucose number, time, and reading tag are all saved in the meter’s memory and can be sent later. Additionally, Telcare will offer free smartphone applications that automatically receive data from the blood glucose meter, create reports, conduct trend analysis, and even incorporate social media sites like Facebook and Twitter. Telcare also has its own social community planned that will be directly integrated into the apps.

Aside from the data upload, one of the meter’s more innovative features is its ability to send messages to the user. After each blood glucose value is sent to the online server, a feedback message appears on screen. When the product is used without a prescription, post-test messages are motivational, such as “You have completed 65% of your targeted tests this week and your glucose is within 30% of target.” (In this case, individuals have input their own target number of tests and target glucose range.) When the meter and targets are prescribed by a health care provider, such as a diabetes educator, physician, or nurse case-manager, the messages can become more medically focused, such as “Good work, Julia. Still a bit above target. Try adding one more unit of insulin before lunch. Testing adherence is 88% this week.” In addition, the meter allows for Q&A with the user, much like the Health Buddy and WellDoc systems. In the demonstration we saw, the onscreen text was phrased in a conversational way and was really quite disarming (note – there is no audio, only words). Keep in mind that the messages can be customized or even turned off – this is important, since we did hear from one person with type 1 that he didn’t want to be told what to do by a meter!

This sort of blood glucose test and trend information strikes us as potentially quite helpful. Diabetes can be isolating, but we think that getting real-time feedback along with the data to contextualize it will be motivating. What’s more, in keeping with the trend of greater electronic contact between doctors and patients, healthcare providers can message or send multiple-choice queries to patients directly on the meter (for example, if they see that many dangerous low or high blood sugars have occurred recently).

The meter can also simplify the complex logistics of diabetes care. For example, if the meter is linked to the healthcare provider’s own electronic scheduling system, the system can automatically send queries such as, “Susan, our records indicate that you have an appointment this Thursday. Please confirm by calling 415 241 9500,” or “Mary, our records show you have not had your annual eye or foot exam this year. Would you like to schedule now? (Y/N).” Additionally, the server keeps track of how many strips people have used, and they can use the meter to reorder supplies by responding to messages, like “Zach, your average BG today is 136 mg/dl. You are running low on supplies. Would you like to reorder? (Y/N).” If yes, the meter then messages Telcare Medical Supply, Inc. (Telcare has a durable medical equipment entity, as well) and supplies are delivered, pending insurance approval. The reimbursement process will be set up in Telcare’s “back office”; in many cases no further documentation or contact would be needed prior to delivery.

Other features of the meter include a color screen, a rechargeable battery, and high accuracy. Interestingly, its high accuracy was what really got our attention to begin with - Telcare’s meter is within 10% accuracy of laboratory measurements 95% of the time, compared with the FDA’s current requirement of 20% (for more information on this topic, please see the Learning Curve in diaTribe #22). This is the first meter we have seen with this level of accuracy that will be in the label – though we expect accuracy to continue to improve across the industry, we were happy to see this prioritized from the start with this meter.

The meter is slightly larger than average (about the size of a Blackberry, and a little thicker), though not bigger than the other larger meters that are used today. It weighs 115 g (4.06 oz), which is less than most smartphones but more than twice as heavy as most leading blood glucose meters. The company will offer 24/7 customer service, similar to other major meter companies.

So what’s not to like? Well, this is a new business model – and people will be able get a free meter only by making a two year commitment to using Telcare’s test strips (and a reduced-price meter only by making a shorter commitment). Those not wanting to make a commitment to test strips will be offered a retail price of around $100. Unlike all of the other wireless strategies we have seen, however, the cellular service fees are included in the price of the test strips, which is good news for customers. As we understand it, the cost for 50 strips will be in the same range as those for current “branded” (not discount) meters. Notably, Medicare will provide reimbursement for strips and for the meter on the same basis as other glucose meters. What does this mean? Medicare will chip in roughly $50 for the first meter, and individuals will pay the balance out of pocket. Private insurers, meanwhile, might also contribute – Telcare is currently in reimbursement discussions with various insurers, payers, and employers.

We really like that this meter will simplify data downloading, enabling people to better understand, contextualize, and control their diabetes. We’re also glad to see Telcare make it easier to involve doctors and nurses — we believe this meter will really help “individualize” therapy, just as recent care guidelines have recommended. On a related note, we also hope to see insurance companies reimburse doctors and nurses for more time spent helping patients manage their blood glucose – short-term investment here may well yield longer-term rewards, and we look forward to seeing data on this front. In the meantime, Telcare itself plans to compensate doctors and nurses for the time it takes them to thoroughly train their patients on the different advanced functions of the meter and web portal. We also hope to see insurance companies reimburse doctors and nurses for more time spent helping people manage their blood glucose so that they are paid for ongoing analysis as well as training. We eagerly anticipate the meter’s launch later this year, and we note that interested readers can enter their email address on Telcare’s website (www.telcare.com) to be informed when it will be available for purchase. We’ll stay tuned for further developments from this company, and we hope to Test Drive the meter once it becomes available. --AB/KC