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April 30th, 2012
The personal glucose meter is the most important advance in diabetes care in my thirty-five years of living with type 1. What if this humble machine is the killer app that will reform health care?
Personal electronic devices are transforming commerce through disintermediation, meaning that the internet and high-speed computing give you direct access to the information you need when you need it. In traditional medicine, you go the the doc and a test is performed on your blood. The doc gets the result, usually days later, and if nothing is wrong you may hear nothing. The notion is that you are not qualified to understand the test.
Well, in this new age you are qualified! Surely glucose leads the way in the frequency of personal self-tests. Sometimes nondiabetic friends ask to check their glucose on my meter because they are curious or fearful about diabetes. I imagine that some people have discovered their diabetes with a friend’s glucose meter, then sought treatment.
Any successful technology tends to spread into adjacent space. A recent research publication by Xiang and Liu describes some pioneering work in using a personal glucose meter to measure other blood components. The basic idea is simple: since the meter measures glucose levels, we use chemistry to cause glucose to appear in the presence of the analyte of interest. And the amount of glucose present provides a way to measure the analyte.
The diagram above shows how it works. In this case, an antibody against PSA (prostate-specific antigen, the glycoprotein elevated in the presence of prostate cancer) is attached to a bead (often latex). When mixed with blood, PSA protein becomes attached to the antibody. Then another antibody attaches to the PSA analyte; this second antibody is mated to an enzyme (invertase) that transforms sucrose (table sugar) into glucose. The glucose is detected in the normal way by the personal glucose meter. This simple system works because the more PSA is present, the more invertase is active, and thus the more glucose appears.
So, guys, if you are concerned that you might have undetected prostate cancer, you could buy a special BG strip that reveals your PSA levels (and your prostate cancer risk) instead of your sugar. Getting the answer takes a few seconds. Reassurance may be on the way.
This kind of self-diagnosis would be the ultimate in personal health management! Or make it a party — imagine the fun of screening your friends for cancers, or viruses like hepatitis. Medical economists tell us that early detection is an important step in controlling health care costs. With Personal Diagnostic Meters, we can all be part of the solution.
And the applications are not limited to disease. You could measure your fatigue level, then call your boss and tell her, “My meter says I need a day off.” It will also be possible to measure drugs of abuse. Parents, you could test your teenagers the moment they come home from a worrisome party, and not just for alcohol levels. You could test on the spot for the newest and most fashionable drugs of abuse.
Hormones can get in the act too. Have a date with a special woman, but aren’t sure how she really feels about you? As a fun feature of the date, you could check each other for some innocent marker — do you both have Estonian ancestry? But secretly you are testing her for love pheromones, so you would know in seconds, as well as science can measure it, that she loves you. Or not. No more guesswork.
Yes, it will be a new era. Millions have already surrendered their personal privacy through Facebook and Twitter. Now, with your enhanced glucose meter, you’ll be able to surrender your medical privacy too — or invade someone else’s. It’s crowd sourcing with a twist, pioneered by people with diabetes.