Christopher Jacobs, PhD

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	For those of us involved in the delivery or financing of healthcare, acutely feel the frustration of disease progression and increased healthcare costs due to patient non-compliance. While the term, “non-compliance of prescribed treatment” has now fallen out of favor, and “barriers to care” is now the preferred expression, regardless of the phrase used, the results are the same. That is, patients not following the advice of their health care providers results in increased office, or the significantly more expensive, emergency room visit. While this holds true in most avenues of health care, it is particularly obvious in the treatment of diabetes as compliance to the prescribed glucose testing protocol must be managed by the patients themselves.

	The common barriers to care for those who aren’t checking blood sugar as often as they should are as follows:

	1. The anxiety and pain of the repeated “fingerstick” (needle-phobia).

	3. Cost of medical supplies, especially test strips.

	4. Not being in a location where it is appropriate to test (e.g., driving).

	The anxiety and pain of the fingerstick is the most prevalent, and yet most controllable by the healthcare community. This article will describe three reasons how overcoming the barrier caused by the dreaded fingerstick will not only improve patient outcomes, but will also contribute to a significant reduction in healthcare costs.

	1. When blood glucose checking doesn’t hurt, patients test more often.

	2. When patients test more often, their A1c drops, frequently more than 1%, according to a 2011 

	3. With every 1% point drop in A1c, on average, there is an annual saving in healthcare costs of up to $1,457 per patient, as well as better outcomes, according to several studies, including those published in peer reviewed journals.

Patients test more often if it doesn’t hurt.

 Not only is this intuitively obvious, but there is evidence that those with diabetes claim to have many reasons for not testing. In one-on-one interviews, patients revealed that avoidance of fingerstick pain was the primary reason they didn’t test as often as possible.

	This was understandable because traditional clinical thinking had been that only blood drawn from painful fingerpricks was valid. Fortunately, except for the very rare cases of rapidly changing blood glucose levels, evidence from clinical trials, including a 

American Association of Diabetes Educators

 verifies that testing from alternate sites; specifically the palms will provide readings virtually identical to fingers, within meter accuracy. In addition, the FDA, which is staying current on this new data, has recently cleared a standalone lancing device for alternate site testing.

	Painless lancing is achieved by precisely controlling lancing depth so the needle only reaches the surface capillaries, not the deeper pain nerves. As soon as lancing is completed, vacuum is automatically applied to this very shallow site, drawing out the required blood drop.  

Testing more often leads to lower patient A1cs

. It is well-documented that when those with diabetes test their blood sugar more often, their A1c numbers improve. With increased testing and subsequent awareness of blood glucose numbers, patients lead to not only better dosing, but also better focusing on achieving a healthier lifestyle, including diet and exercise.

	Additional advantages of using more frequent testing as a means of lowering A1c include:

	·  There are no incompatibility with other drug treatments.

	·   There is relatively low-implementation cost.

	Further evidence that pain-elimination can lead to increased testing frequency and lower A1cs has been documented in a survey sent out to 1,500 patients with diabetes who tested using this technology. Of those who responded (approximately 14%), data showed that when converting from conventional lancing devices to a painless lancing device:

			96% of respondents had significant pain reduction.

			76% were testing their blood sugar more often.

			44% had a 1 point or better decrease in their A1c numbers.

			86% had increased satisfaction with their testing procedure.

Savings in healthcare costs per point drop in A1c

. There are a substantial number of peer reviewed articles, including a 

American Journal of Preventative Medicine

 which has calculated savings of a 1% point drop in A1c. Average annual savings, depending on source, are between $685 and $1,457 per year per patient.

	Extrapolating the data leads to an annual dollar savings of between $701 and $1,503 in healthcare cost per patient. While the traditional clinical thinking reasons that in order to get the most accurate readings it necessary to only lance from the more painful fingertips, by using newer technologies and knowledge, patients consistently attain not only better outcomes but also significant reductions in healthcare costs. This newer paradigm leads to lower A1cs, a significant saving in healthcare costs, and improved patient outcomes.

Christopher A. Jacobs is the founder and CEO/chief research engineer for 

. He is a biomedical engineer with more than 31 patents worldwide in durable medical devices, as well as a thought leader and expert on diabetes management and associated healthcare cost reduction, including how those with diabetes, their caregivers, and those in the medical industry can reduce the long-term costs imposed by the barriers to care

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Here are 3 reasons why overcoming the “fingerstick” barrier will improve patient outcomes and contribute to reductions in healthcare costs.

Christopher Jacobs, PhD

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