Sleep apnea has long been known to be associated with obesity, but a new study published in the June 2009 issue of Diabetes Care finds the disorder is widely undiagnosed among obese individuals with type 2 diabetes — nearly 87 percent of participants reported symptoms, but were never diagnosed.

For those with untreated sleep apnea, it doesn’t just mean their sleep is disrupted; existing research shows that it can also mean an increased risk of heart disease and stroke.

"The high prevalence of undiagnosed, and therefore, untreated sleep apnea among obese patients with diabetes constitutes a serious public health problem," said Gary Foster, PhD, lead author and director of the Center for Obesity Research and Education at Temple University.

The new study, called Sleep AHEAD, looked at 306 obese patients with type 2 diabetes already enrolled in the Look AHEAD trial, a 16-site study investigating the long-term health impact of an intensive lifestyle intervention in 5,145 overweight or obese adults with type 2 diabetes.

Each participant had a sleep study (polysomnogram) that measures various breathing and brain activity during sleep. Participants also filled out a series of questions about symptoms related to sleep (snoring, sleepiness during the day), and had their weight, height, waist, and neck circumferences measured.

Researchers found that 86.6 percent of participants had sleep apnea, yet reported never being diagnosed. More than 30 percent of these had between 16 and 20 episodes per hour where they would stop breathing, and 22 percent had more than 30 episodes per hour, considered severe sleep apnea. Most of these also had a larger waist circumference, which researchers found, along with higher BMI, to be significantly associated with sleep apnea.

Obesity has long been known to be associated with sleep apnea, but researchers say that these findings are alarming.

"Doctors who have obese patients with type 2 diabetes need to be aware of the possibility of sleep apnea, even if no symptoms are present, especially in cases where the patient has a high BMI or waist circumference," said Foster.

Currently, more than half of obese or overweight individuals have diabetes, the seventh leading cause of death in the United States.

Other authors on the study were Kelley Borradaile, PhD from Temple University; Mark Sanders, MD, Anne Newman, MD, David Kelley, MD, from the University of Pittsburgh; Richard Millman, MD, Rena Wing, PhD from Brown University; Garry Zammit, MD from Clinilabs; Thomas Wadden, PhD, Valerie Darcey, MS, and Samuel Kuna from the University of Pennsylvania; F. Xavier Pi Sunyer from Columbia University; and the Sleep AHEAD Research Group. Funding was provided by grants from the National Institutes of Health: National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases.

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To the many problems associated with lack of sleep — moodiness, memory problems, difficulty concentrating — add the risk of developing diabetes.

A study from the University at Buffalo shows that people who sleep less than six hours a night during the work-week are 4½ times more likely to have elevated levels of blood sugar than those who slumber 6-to-8 hours.

The findings were being presented at the American Heart Association’s 49th annual Conference on Cardiovascular Disease Epidemiology and Prevention.

"Impaired fasting glucose — a reading higher than 100 — is known as pre-diabetes, which is a precursor to type 2 diabetes," said Lisa Rafalson, Ph.D., a National Research Service Award (NRSA) Fellow in the University of Buffalo Department of Family Medicine and first author on the study.

"In fact, about 25 percent of people who have impaired fasting glucose will at some point develop type 2 diabetes, which is associated with many complications, including heart disease and premature death." Rafalson also is a research assistant professor is UB’s Department of Social and Preventive Medicine.

Rafalson’s findings were based on data from an average six-year follow-up of participants who initially took part in the Western New York Health Study, conducted from 1996–2001. The 91 persons with normal fasting glucose levels at baseline who developed pre-diabetes by their follow-up exam were matched to persons from the study who had maintained normal glucose levels who served as controls.

Participants were placed into three groups based on the average daily amount of sleep they reported receiving from Sunday through Thursday: short-sleepers — those who reported less than six hours of sleep nightly; long-sleepers, who reported sleeping more than eight hours nightly; and a reference group who slept 6-to-8 hours a night.

Results showed that "short-sleepers" had a significantly increased risk of progressing from normal glucose levels to pre-diabetes, compared to those who slept 6-8 hours nightly. Sleeping an average of more than 8 hours a night had no significant effect on glucose levels, results showed.

"This study supports growing evidence of the association of inadequate sleep with adverse health issues," said Rafalson. She suggested that during annual "well visits”, physicians should discuss sleep habits with their patients, along with diet and exercise and other lifestyle issues that are important to long-term health.

Findings from the National Sleep Foundation’s 2005 Sleep In America poll found that patients didn’t offer and doctors didn’t ask about sleep. The findings found that Americans were, on average, too sleepy for sex. Two findings from the 2005 Sleep In America poll were:

Health care providers must:

• Talk to their patients about sleep and recognize the relationship between sleep issues and other medical conditions.
• Ask your patients "How often do you get a good night’s sleep?"

"Genetic susceptibility is always a possible explanation for this finding," Rafalson noted, "but it is more likely that pathways involving hormones and the nervous system are involved in the impaired-sleep/fasting glucose association.

"We hope our findings will generate more research into this complex relationship between sleep and illness," she said.

Additional authors on the study are Richard P. Donahue, Ph.D., M.P.H.; Michael LaMonte, Ph.D., M.P.H.; Joan Dorn, Ph.D.; Maurizio Trevisan, M.D., M.S.; Saverio Stranges, M.D., Ph.D.; and Jacek Dmochowski, Ph.D. All authors are current or former members of the Department of Social and Preventive Medicine, UB School of Public Health and Health Professions.

Trevisan now heads the University of Nevada Health Sciences System; Stranges is affiliated with the Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK, and Dmochowski is affiliated with the University of North Carolina, Charlotte.

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People with a habit of getting in a power nap during lunch could increase the risk of developing Type 2 diabetes, according to the findings of a research study being presented this week at Diabetes UK’s Annual Professional Conference in Glasgow.

Researchers at the University of Birmingham looked at the napping habits of 16,480 people and found that diabetes prevalence increased with napping frequency, and those who napped had a 26 percent greater risk of developing Type 2 diabetes compared to those who never napped.

Sleep’s links with Type 2 risk

The researchers believe that an association between napping and reduced physical activity may be behind the link. Napping during the day may also disrupt nighttime sleep. Short nighttime sleep duration has already been associated with increased Type 2 diabetes risk.

In addition, waking from napping activates hormones and mechanisms in the body that stop insulin working effectively. This could also predispose people to Type 2 diabetes, which may lead to the development of diabetes when the insulin the body makes does not work properly.

Link between disturbed night sleep patterns and the diabetes risk

"We know from previous studies, which looked at the link between disturbed night sleep patterns and the risk of developing Type 2 diabetes, that interrupted sleep at night could increase the risk of developing Type 2 diabetes," said Dr. Iain Frame, director of Research at Diabetes UK.

"We already know that people who are overweight or obese, and therefore more at risk of developing Type 2 diabetes, can have problems sleeping,” added Frame. Continuing, he said, “This new research could be another step towards explaining the possible link between disturbed sleep patterns and Type 2 diabetes.”

Less significant than established risk factors

"However, in terms of being major risk factors for developing Type 2 diabetes, disturbed sleep or napping are likely to remain less significant than already established risk factors such as being overweight, being over the age of 40 or having a history of diabetes in the family," Frame noted.

"Our research provides us with an additional insight on the risk factors behind Type 2 diabetes,” says researcher Shahrad Taheri, from the University of Birmingham. "As the number of people with Type 2 diabetes keeps increasing, it is crucial that we do everything we can to help prevent people from developing the condition."

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ANN ARBOR, Mich. — A new report suggests treating gum disease in diabetic patients with procedures such as cleanings and periodontal scaling is linked to 10–to–12 percent lower medical costs per month.

The findings are encouraging but the study was not designed to firmly establish cause–and–effect, said George Taylor, University of Michigan associate professor of dentistry, who also has an appointment in epidemiology in the U–M School of Public Health. Taylor led the research project to investigate whether routine, non-surgical treatment for gum disease is linked to lower medical care costs for diabetics.

In periodontal disease, the body reacts to the bacteria causing the gum infection by producing proteins or chemicals called inflammatory mediators. Ulcers and open sores in the gums become passageways for these proteins and for the bacteria themselves to enter the body’s blood circulation. These inflammatory mediators, as well as some parts of the bacteria, prevent the body from effectively removing glucose, or sugar, from the blood.

The higher level of blood sugar is known as poor diabetes control. Poor diabetes control leads to serious diabetes complications such as vision disorders, cardiovascular and kidney disease and amputations, among others.

"Cleanings and other non–surgical periodontal treatment remove the harmful bacteria," Taylor said. "We believe this helps prevent the body from producing those harmful chemicals that can enter the systemic circulation and contribute to poorer diabetes control."

Blue Care Network provided U–M researchers data from 2,674 patients aged 18-64 who were enrolled in BCN between 2001 and 2005 and had at least 12 consecutive months of medical, dental, and pharmaceutical coverage.

"We found insured adults with diabetes in Michigan who received routine periodontal treatment, such as dental cleanings and scaling, have significantly lower medical care costs than those who do not," Taylor said. "These results could be meaningful to individuals, employers, health care providers and insurers."

The study showed that medical care costs decreased by an average of 11 percent per month for patients who received one or two periodontal treatment procedures annually compared to those who received none. For patients receiving three or four annual treatments, costs decreased nearly 12 percent.

The study also showed that combined medical and pharmaceutical monthly costs were 10 percent lower for patients who received one or two periodontal procedures annually.

"The results of our analyses provide additional evidence supporting a beneficial role for periodontal treatment in improving overall health for people with diabetes," Taylor said. The findings could fuel changes in policies and practices for diabetes patients and their insurers.

The research was supported by a grant from the Blue Cross Blue Shield of Michigan Foundation. Taylor’s team includes: Wenche Borgnakke, senior research associate in health sciences; Michael Manz, senior research associate in health sciences; and Tammie Nahra, assistant research scientist.

The University of Michigan School of Dentistry is one of the nation’s leading dental schools engaged in oral health care education, research, patient care, and community service. General dental care clinics and specialty clinics providing advanced treatment enable the School to offer dental services and programs to patients throughout Michigan. Classroom and clinic instruction prepare future dentists, dental specialists, and dental hygienists for practice in private offices, hospitals, academia, and public agencies. Research seeks to discover and apply new knowledge that can help patients worldwide.

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A study published in the December 15, 2008 issue of the Journal of Clinical Sleep Medicine suggests that screening patients with Type 2 diabetes for obstructive sleep apnea (OSA) and treating those who have obstructive sleep apnea with continuous positive airway pressure (CPAP) and bi-level positive airway pressure (bi-level/BiPAP), or generically xPAP, therapy could improve the management of their hyperglycemia and might favorably influence their long-term prognosis.

According to Arthur Dawson, M.D., division of Chest and Critical Care Medicine, Scripps Clinic Sleep Center, La Jolla, California, it is not surprising that many diabetics have sleep apnea since Type 2 diabetes and obstructive sleep apnea are both conditions that are becoming much more common because of the obesity epidemic.

"The low blood oxygen level and the arousals associated with an apneic event activate the sympathetic nervous system and cause the release of stress hormones, both of which tend to raise the blood glucose. If we could prevent these apneic events with CPAP or bi-level/BiPAP, then we might keep the glucose level lower and more stable through the night," said Dawson.

For the study, 20 patients with Type 2 diabetes who were on a stable diabetic regime were recruited at the time of their initial consultation with a sleep physician. All participants were newly diagnosed with moderate to severe obstructive sleep apnea, and none had any previous experience with CPAP or bi-level positive airway pressure/BiPAP".

Glucose level was monitored with a continuous glucose monitoring system (CGMS) over a period of 36 hours, which included a night in a sleep laboratory for evaluation by polysomnography. On the first night of the study, patients’ obstructive sleep apnea was untreated.

A second night of glucose monitoring and sleep recording was done after the participants had been on xPAP therapy for a duration of one-to-three months. No changes were made in participants’ diets or medication for diabetes throughout the study.

Results showed that in a group of 20 patients with Type 2 diabetes who were mostly obese and were newly diagnosed with obstructive sleep apnea, sleeping and nocturnal hyperglycemia were reduced and the sleeping interstitial glucose level was less variable during xPAP treatment.

The average glucose level during sleep decreased by approximately 20mg/dL after an average of 41 days of xPAP. The sleeping glucose also was more stable after treatment, with the median standard deviation decreasing from 20.0 to 13.0 and the mean difference between maximum and minimum values decreasing from 88 to 57.

The authors believe that recognizing and treating obstructive sleep apnea could improve the outlook for diabetics who also suffer from obstructive sleep apnea. Researchers involved in this study theorized that by using the CGMS they were able to pick up short-term changes in the glucose level that would not be detected by traditional measurements.

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A press release issued by the American Association of Diabetes Educators says that 94 percent of doctors in a survey the organization conducted were aware of the links between the development of type 2 diabetes in people who have obstructive sleep apnea.

Despite knowing about the link, only about 47 percent of the physicians involved in the survey actually conduct routine screenings.

The press release indicates a sleep apnea screening protocol designed to close the gap between theory and practice will be presented at the American Association of Diabetes Educators annual meeting.

Obstructive sleep apnea (OSA) is a potentially life-threatening condition which can lead to many health issues, including diabetes, memory loss, cognitive function issues, greater risk for involvement in motor vehicle accidents, greater risk of heart attacks and strokes, depression or moodiness, among other issues. Obstructive sleep apnea alone is believed to affect an estimated 18 million people in the U.S.

According to the press release, at least 30 percent of people who suffer from obstructive sleep apnea also have type 2 diabetes.

Although the majority of doctors and diabetes educators are aware of the close connection between obstructive sleep apnea and type 2 diabetes, the press release continues, little has been done in clinical practice to take the steps needed to diagnose and treat sleep apnea in this patient population.

A growing coalition of health professionals and organizations are supporting calls for screening. The latest organizations to join in the call include:

A recent survey of doctors at the American Diabetes Association meeting found that although 94 percent of doctors recognize a relationship between obstructive sleep apnea and type 2 diabetes, 47 percent of those same doctors do not routinely screen type 2 diabetic patients for obstructive sleep apnea. Results from the previous year’s survey, which had the same questions, demonstrate the trend has not changed over the past year.

The International Diabetes Federation (IDF) issued a June 2008 consensus statement calling for doctors and diabetes educators to begin taking necessary steps to diagnose and treat sleep apnea in people with diabetes, noting that treating OSA can help make in the overall management of type 2 diabetes.

In issuing its call to action, the IDF said it’s imperative for health care professionals to:

• generate awareness about the connection between obstructive sleep apnea and type 2 diabetes;
• conduct research to better understand the links between the two conditions; and
• develop new clinical practices that address treatment.

While many people with obstructive sleep apnea snore loudly and frequently, following by periods of silence when airflow is reduced or blocked, and then come to a conclusion when the person begins to make choking, snorting, or gasping sounds when the person’s airway reopens.

Almost everyone is likely to snore at one time or another, and while most people with apnea snore, not everyone who snores has apnea. It has been found in all age groups. Estimates of snoring vary widely based on how it is defined.

Habitual snoring has been found in about 24 percent of adult women and 40 percent of adult men. Both men and women are more likely to snore as they age. Men, however, become less likely to snore after the age of 70.

Obstructive sleep apnea is best treated by the use of a positive airway pressure device, such as a continuous positive airway pressure device, or CPAP, or a bi-level positive airway pressure device, or bi-level. Some people mistaken refer to all bi-level devices as BiPAP machines, although the word BiPAP is a registered trademark of Respironics, Inc., for a specific line of bi-level devices. The term xPAP is used when speaking of positive airway pressure machines, overall, when one specific type of machine is not being discussed.

Other treatments for apnea exist, though the success rate at eliminating the apneas — especially without surgery — are not close to the almost 100 percent success rate of xPAP devices. They include oral devices, including custom devices made by dentists; surgeries; and an implant that’s been on the market for a few years with mixed comments.

Suppression of slow-wave sleep in healthy young adults significantly decreases their ability to regulate blood-sugar levels and increases the risk of type 2 diabetes.

Deep sleep, also called "slow-wave sleep," is thought to be the most restorative sleep stage, but its significance for physical well-being has not been demonstrated. This study found that after only three nights of selective slow-wave sleep suppression, young healthy subjects became less sensitive to insulin.

Although they needed more insulin to dispose of the same amount of glucose, their insulin secretion did not increase to compensate for the reduced sensitivity, resulting in reduced tolerance to glucose and increased risk for type 2 diabetes. The decrease in insulin sensitivity was comparable to that caused by gaining 20 to 30 pounds.

Previous studies have demonstrated that reduced sleep quantity can impair glucose metabolism and appetite regulation resulting in increased risk of obesity and diabetes. This current study provides the first evidence linking poor sleep quality to increased diabetes risk.

"These findings demonstrate a clear role for slow-wave sleep in maintaining normal glucose control," said the study’s lead author, Esra Tasali, MD, assistant professor of medicine at the University of Chicago Medical Center. "A profound decrease in slow-wave sleep had an immediate and significant adverse effect on insulin sensitivity and glucose tolerance."

"Since reduced amounts of deep sleep are typical of aging and of common obesity-related sleep disorders, such as obstructive sleep apnea these results suggest that strategies to improve sleep quality, as well as quantity, may help to prevent or delay the onset of type 2 diabetes in populations at risk," said Eve Van Cauter, PhD, professor of medicine at the University of Chicago and senior author of the study.

"These findings shed light on a problem faced by many elderly, that of fragmented sleep and less time spent in restorative sleep," said Andrew Monjan, PhD, MPH, chief of the Neurobiology of Aging Branch at the National Institute on Aging, which partially funded the research. "More research is needed into the link between insufficient sleep and common metabolic disturbances of later life, such as type 2 diabetes and obesity."

The researchers studied nine lean, healthy volunteers, five men and four women between the ages of 20 and 31. The subjects spent two consecutive nights in the sleep laboratory, where they went to bed at 11 p.m., slept undisturbed but carefully monitored, and got out of bed 8.5 hours later, at 7:30 a.m.

The same subjects were also studied for three consecutive nights during which they followed identical nighttime routines. During this session, however, when their brain waves indicated that they were drifting into slow-wave sleep they were subtly disturbed by sounds administered through speakers beside the bed.

These sounds were loud enough to disrupt deep sleep but not so loud as to cause a full awakening. This technique enabled the researchers to decrease slow-wave sleep by about 90 percent, shifting the subjects from the onset of deep sleep (stage 3 or 4) to a lighter sleep (stage 2) without altering total sleep time.

"Our system proved quite effective," Tasali said. When asked about the sounds the next morning, study subjects vaguely recalled hearing a noise "three or four times," during the night. Some recalled as many as 10 to 15. On average, however, subjects required about 250 to 300 interventions each night, fewer the first night but more on subsequent nights as "slow-wave pressure," the body’s need for deep sleep, accumulated night after night.

"This decrease in slow-wave sleep resembles the changes in sleep patterns caused by 40 years of aging," Tasali said. Young adults spend 80 to 100 minutes per night in slow-wave sleep, while people over age 60 generally have less than 20 minutes. "In this experiment," she said, "we gave people in their 20s the sleep of those in their 60s."

At the end of each study, the researchers gave intravenous glucose (a sugar solution) to each subject, then took blood samples every few minutes to measure the levels of glucose and insulin, the hormone that controls glucose uptake.

They found that when slow-wave sleep was suppressed for only three nights, young healthy subjects became about 25 percent less sensitive to insulin. As insulin sensitivity decreased, subjects needed more insulin to dispose of the same amount of glucose. But for eight of the nine subjects, insulin secretion did not go up to compensate for reduced effects. The result was a 23 percent increase in blood-glucose levels, comparable to older adults with impaired glucose tolerance.

Those with low baseline levels of slow-wave sleep had the lowest levels after having their sleep patterns disrupted and the greatest decrease in insulin sensitivity.

The alarming rise in the prevalence of type 2 diabetes is generally attributed to the epidemic of obesity combined with the aging of the population. "Previous studies from our lab have demonstrated many connections between chronic, partial, sleep deprivation, changes in appetite, metabolic abnormalities, obesity, and diabetes risk," said Van Cauter. "These results solidify those links and add a new wrinkle, the role of poor sleep quality, which is also associated with aging."

"Chronic shallow non-REM sleep, decreased insulin sensitivity and elevated diabetes risk are typical of aging," the authors conclude. "Our findings raise the question of whether age-related changes in sleep quality contribute to the development of these metabolic alterations."

Suppression of slow-wave sleep in healthy young adults significantly decreases their ability to regulate blood-sugar levels and increases the risk of type 2 diabetes, report researchers at the University of Chicago Medical Center in the “Early Edition” of the Proceedings of the National Academy of Science.

Deep sleep, also called “slow-wave sleep,” is thought to be the most restorative sleep stage, but its significance for physical well-being has not been demonstrated. This study found that after only three nights of selective slow-wave sleep suppression, young healthy subjects became less sensitive to insulin.

Although they needed more insulin to dispose of the same amount of glucose, their insulin secretion did not increase to compensate for the reduced sensitivity, resulting in reduced tolerance to glucose and increased risk for type 2 diabetes. The decrease in insulin sensitivity was comparable to that caused by gaining 20 to 30 pounds.

Previous studies have demonstrated that reduced sleep quantity can impair glucose metabolism and appetite regulation resulting in increased risk of obesity and diabetes. This current study provides the first evidence linking poor sleep quality to increased diabetes risk.

"These findings demonstrate a clear role for slow-wave sleep in maintaining normal glucose control," said the study’s lead author, Esra Tasali, M.D., assistant professor of medicine at the University of Chicago Medical Center. "A profound decrease in slow-wave sleep had an immediate and significant adverse effect on insulin sensitivity and glucose tolerance."

“Since reduced amounts of deep sleep are typical of aging and of common obesity-related sleep disorders, such as obstructive sleep apnea these results suggest that strategies to improve sleep quality, as well as quantity, may help to prevent or delay the onset of type 2 diabetes in populations at risk,” said Eve Van Cauter, Ph.D., professor of medicine at the University of Chicago and senior author of the study.

The researchers studied nine lean, healthy volunteers, five men and four women between the ages of 20-and-31. The subjects spent two consecutive nights in the sleep laboratory, where they went to bed at 11 p.m., slept undisturbed but carefully monitored, and got out of bed 8½ hours later, at 7:30 a.m.

The same subjects were also studied for three consecutive nights during which they followed identical nighttime routines. During this session, however, when their brain waves indicated that they were drifting into slow-wave sleep they were subtly disturbed by sounds administered through speakers beside the bed.

These sounds were loud enough to disrupt deep sleep but not so loud as to cause a full awakening. This technique enabled the researchers to decrease slow-wave sleep by about 90 percent, shifting the subjects from the onset of deep sleep (stage 3 or 4) to a lighter sleep (stage 2) without altering total sleep time.

"Our system proved quite effective," Tasali said. When asked about the sounds the next morning, study subjects vaguely recalled hearing a noise "three or four times," during the night. Some recalled as many as 10-to-15. On average, however, subjects required about 250-to-300 interventions each night, fewer the first night but more on subsequent nights as "slow-wave pressure," the body’s need for deep sleep, accumulated night after night.

"This decrease in slow-wave sleep resembles the changes in sleep patterns caused by 40 years of aging," Tasali said. Young adults spend 80-to-100 minutes per night in slow-wave sleep, while people over age 60 generally have less than 20 minutes. "In this experiment," she said, "we gave people in their 20s the sleep of those in their 60s."

At the end of each study, the researchers gave intravenous glucose (a sugar solution) to each subject, then took blood samples every few minutes to measure the levels of glucose and insulin, the hormone that controls glucose uptake.

They found that when slow-wave sleep was suppressed for only three nights, young healthy subjects became about 25 percent less sensitive to insulin. As insulin sensitivity decreased, subjects needed more insulin to dispose of the same amount of glucose. But for eight of the nine subjects, insulin secretion did not go up to compensate for reduced effects. The result was a 23 percent increase in blood-glucose levels, comparable to older adults with impaired glucose tolerance.

Those with low baseline levels of slow-wave sleep had the lowest levels after having their sleep patterns disrupted and the greatest decrease in insulin sensitivity.

The alarming rise in the prevalence of type 2 diabetes is generally attributed to the epidemic of obesity combined with the aging of the population.

"Previous studies from our lab have demonstrated many connections between chronic, partial, sleep deprivation, changes in appetite, metabolic abnormalities, obesity, and diabetes risk," said Van Cauter. "These results solidify those links and add a new wrinkle, the role of poor sleep quality, which is also associated with aging."

"Chronic shallow non-REM sleep, decreased insulin sensitivity and elevated diabetes risk are typical of aging," the authors conclude. "Our findings raise the question of whether age-related changes in sleep quality contribute to the development of these metabolic alterations."

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Here’s information on two new diagnostic products. These two are both sold over-the-counter for people with diabetes.

The FDA recently cleared for marketing two glucose test meters for use in conjunction with hand-held computers. The computer technology allows diabetics to do a better job of tracking and managing their blood sugar levels.

The devices are the FreeStyle Tracker Diabetes Management System, by TheraSense, Inc., of Alameda, California, and the Accu-Check Advantage Module, by Roche Diagnostics Corporation, of Indianapolis.

These products, for the first time, combine a glucose test meter with a hand-held computer, in this case a compatible personal digital assistant, or PDA. The new system not only measures and tracks glucose levels, it’s also able to monitor and record other important data, such as insulin usage, food intake, exercise, and medications.

The patient uses the device by first inserting a glucose meter module into the hand-held computer. Then a test strip is inserted into the meter and a blood sample is collected and placed onto the test strip. The glucose levels are then read by the meter. The computer displays the results and saves them in a database which has the ability to store up to 2,500 entries. The results can be uploaded to a PC and printed out, or viewed at a later time.

Of course, it’s important that patients know how to operate a PDA before they use this system.

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