Please consult the manual of both devices. You will see that their results will always deviate by at leat +/-15%. The freestyle was off by -15% and the relion by +15%. With the next test they can deviate into the opposite direction. A coincidence but still perfectly normal. Only lab equipment can tell which result was more in line with the real blood glucose.
Sure, but it could vary as much as 15%, so, yeah, big coincidence but I would think that if it is a consistent difference that there is something going on.
I always check my Aviva meter against my regular labs. It's never been off by more than 5 points. Checking my meter against my labs is how I knew my Omnipod Freestyle was reading as much as 30 points lower than my Aviva on a consistent basis.
But how should "consistent" be defined with random variability due to multiple factors (see article?
I am not sure if the US market allows meters to follow different calibration standards: plasma VS whole blood calibration. I would assume that today only plasma calibration is common or even regulated by the FDA. I have used both calibration systems and got consistent differences in the glucose levels of these devices.
That's a good point Holger which is why the whole field of probability exists in the first place.
I guess I would say that, given the number of variables, if you have two different meters and every single time you take a measurement, regardless of the range of results ("high" versus "low"), one meter reads lower than the other, I'd call that a consistent result and not an artifact. In fact, that's what happened with every meter I tested against the Omnipod Freestyle including the standalone Freestyle and the Freestyle Light. There would be a cluster of readings for these meters while the Omnipod was 10 to 20 points lower without exception.
At the same time, when my Aviva reads within 5 points of lab values every time I've made the comparison, I'd call that consistency as well.
I suppose the whole thing could be formalized through the appropriate set of tests of probability, but I think it is possible to differentiate between consistency and artifact.
I switched to Relion Prime about a year ago. I've been outraged at the prices on other brands of test strips. I'm considering trying the TD meter and strips... $5.99 for the meter, $5.99 for 50 strips, and $5.95 for shipping. The only problem is I'd have to buy a lot of stuff for the purchase to make sense after paying for the shipping.
However, in all the discussion in this thread about accuracy, the ultimate test is the A1C. If we're able to keep our A1C in our desired range, it doesn't matter too much what the meter says.
However, I'd really like to see test results of as many meter/strip combinations as possible. Someone above mentioned Consumer Reports... have they tested meter/strip combinations?
And I'd also like to see some discussion by someone authoritative as to whether a ±15% accuracy is tolerable.
I also feel (with absolutely no supporting evidence) that sampling from certain spots may yield unreliable results. It would be interesting to compare results from all ten fingers at the same time (but not interesting enough that I'm likely to do it).
You can buy Walmart Reli-On strips and meters off their web site and have them sent to your door. I've used them and they work find. Now I use Contour Next strips, they are $85/100 at CVS but only $25.20/100 with free prime shipping at Amazon. I don't know how to explain the price difference but I like it.
i just got blood work done including fasting bg and a1c, and when i got home, i also tested with my relion twice. so i'll report the results. i have had bg in the diabetic range but am not diagnosed as diabetic because my A1c, OGTT, and fasting values did not reach diabetic levels. post prandial readings i took myself did.
if two products yield equivalent health outcomes, i will choose the cheaper one. right now i pay everything out of pocket.
similarly, i eat low carb even though i enjoy higher carb foods because i think i will get better health eating that way, and i want to prevent/delay using insulin. *if* i could get the same level of health eating higher carb, but taking insulin, using more insulin supplies, in essence using more health care dollars for my 'wanting' higher carb food, is that the ethical choice as people are paying for my wants and not my needs? dave, i think i remember you saying once that you could get the same level of control restricting your carb intake, but you didn't want to do that as it would affect your quality of life. aren't you then making people pay for all the extra supplies you need to eat higher carb?
i'm not trying to be insulting. i'm just trying to extend the argument dave originally made about how our healthcare decisions for things we want, but aren't medically necessary, affect healthcare costs.
I think that we need to explore two issues pertaining to supplies:
1) Civil rights and the pursuit of happiness. I realize that not everyone likes pumps, CGMs, this strip or that strip [I use Bayer, preferred by insurance, they seem to read high although this, in turn, seems to have nudged my A1C down...hmmmm...although I made a few other changes over the same period of time...] but those people like me who prefer them should be supported. The ADA prohibits discrimination against people with disabilities and, while diabetes is not entirely disabling, it is a disease that is certainly a financial disability.
2) More normalized BG as a goal, instead of "a number" or "range" which is all of our current goal. It's very clear that there is some higher risk of various compplications at higher A1C levels. It may not be much but I suspect a more effective approach than aiming at the current 6.5-7 range for goals could be developed. While diabetes is difficult, the success of D-moms, such as Ginger Vieira, who shares 5 simple and extremely effective (which is not to say they are not challenging, tips she used that we can all benefit from.
I'm not as interested in strip accuracy. When I switched from One Touch to Bayer, my perception that the Bayer were giving slightly higher readings was unsettling however I just kept at it (1400 strips...eek!) and have pretty much gotten used to it and it's been accurate enough to prevent any problems and provide the support I need. I think that goals and happiness are two things that offer some potential to tangle more effectively with insurance companies who should either support us or, I would think, could be shown to be conspiring in some manner, in which case there'd be something actionable to pursue, as a conspiracy would seem to fall outside of the contracts we have with them? That may be a bit far-fetched but if I'm going to normalize my BG and they don't support me, I would think that would be something to fight about.
dave, i think i remember you saying once that you could get the same level of control restricting your carb intake, but you didn't want to do that as it would affect your quality of life. aren't you then making people pay for all the extra supplies you need to eat higher carb?Not insulted at all. As an aside, its a fair, legitimate question, and you were quite civil -- genuine discussion, rather than just lashing out as some do over this issue.
i'm not trying to be insulting. i'm just trying to extend the argument dave originally made about how our healthcare decisions for things we want, but aren't medically necessary, affect healthcare costs.
To answer: I'm comfortable, given what I pay in premiums and deductibles, that it's abuot a wash for me. The rest of my family uses very little health care during the year, so if we didn't have insurance and pay premiums, our costs would be within 10-20% of what we're paying.
And that racks up to about $15k a year.
As I've argued here and elsewhere, I'm no shill for the health care industry. Show me the evidence that they're laughing all the way to the bank making obscene profits on our backs.
However, as long as people happily pay what they do for iPhones, Microsoft Office, and on and on, and see nothing nefarious about the much higher profit margins this industry yeilds, I'll be very unsympathetic to those trashing an industry creating miracles that not only keep them alive, but continuously make their live better and easier to live -- all making average profits in line with most industries, as long as IT, Entertainment, and one or two others that no one seems to be bothered by -- hypocritically, in my view.
I understand where you're coming from, acid, and in a general sense agree.
The problem is, such ideas can't be analyzed in a vacuum. Everything we consume as diabetics has other human beings behind it with full-time jobs and salaries/wages that need to be paid. Researchers finding these treatments, like insulin analogs, are expensive high-intellects. Drug trials to establish efficacy and safety cost a lot of money. And on and on, nothing you don't know yourself.
These people won't go to their jobs and make our insulin, pumps, etc. if they don't get paid.
Profit margins in the pharma and med device industry are nothing to brag about, in line the with rest of the economy.
Someone's gotta pay. If not you, then you're asking someone else to. And when you do that, they have a legitimate say over how you spend their money.
The best way to keep them off our backs is to make sure that, at the very least, we're appearing to be mindful of their dollars. Seems to me that demanding a certain brand of test strip, for no other reason than, well, that's the one we want, won't go over too well.
I'm old enough (53 on the 23rd) to have watch this pattern go through its full cyle again and again in other circumstances (not necessarily health care). It always has the same end result: The opposite of what everyone wants. Payors see efficiency in the system decline and costs spiral out of control, beneficiaries lose freedom and choice, ultimately being ordered around and unsatisfied with any solution.
Sound familiar?
Dave, look into the TD strips out of AZ if you really want to support the cheapest strips on the market. Note: I have notice a fair amount of error readings out of them. I sometimes recheck three times in a row before I get them to work successfully. I think the trick it to not touch the strip to your finger, and it should work fine. They require slightly more blood than Relion. They ship reliably within three days. They aren't enormously cheaper, but its the principal.TD out of AZ
dave said: "To answer: I'm comfortable, given what I pay in premiums and deductibles, that it's abuot a wash for me. The rest of my family uses very little health care during the year, so if we didn't have insurance and pay premiums, our costs would be within 10-20% of what we're paying."
it seems what you are saying is that you basically are paying for what you and your family use, and if you paid out of pocket, it would almost be the same amount. therefore, you seem to be saying you are paying your way and are not a drag on the system. am i interpreting you correctly?
then would you agree that if you were paying less into the system because your income was less, ie you were less well-off, it would behoove you to eat lower carb in order to get an equal health outcome at lower cost to the healthcare system?
I have used the Relion test strips. They were basically Precision QID strips when I was using them - made by the same company as the Freestyle strips. I used the Precision meters for years and had great A1Cs. The Relion strips were within points of my One Touch strips.
At some point, I will probably use the Relion strips again when I have lousy insurance. Right now I belong to a program through my husband's employer that you put together a plan with a diabetes educator and have certain tests done during the year, and you have no co-pays on your diabetes supplies. That is not going to last forever.
Insurance companies have a "mutual" element in that they represent shared actuarial risk. I think we are more entitled to a particular brand of strip, pump or whatever as we, collectively, have way more data than they can possibly consider. I'm talking about specifically investigating whether or not there is a conspiracy/ price fixing/ etc. going on which is where I think they probably cross lines and would violate what I would consider "good faith". I don't find it reasonable for my insurance company to send letters saying "Medicare says you only get 4 strips/ day so that's what we'll cover" and I think the fact that they "reli on" (ha) Medicare has elements of a conflict of interest that would cross a line of propriety that we can hang our (diabetic...) socks on...
The costs spiral out of control when diabetes is mismanaged.
No one listens to the actuarial recommendations anyway, and their models could totally be set up a little like casino odds, anyway. They are really complicated. Who knows? The ones who know aren't talking.
That's how the prices are calculated. We (all collective people...) can cover whatever they want so it's just a matter of math and willpower. I think the civil rights argument would be the way to get some leverage that we don't currently have to make the case that, in fact, one meter or pump or insulin or whatever is, in fact, the meter/ pump they will cover vs. another one simply because it works better for us, the patients.
Those large strip manufacturers pay barley anything for manufacturing costs. Even small, infant companies are able to undercut them. Its a form a price fixing. They make money by charging more for something that costs very little to manufacture. I think I am disagreeing with your premise a bit, but am still in line with your conclusion because I would like to pull $$ out of the hands of the health care system and try to hold them accountable to 'true' market forces. Insurance creates an oasis where the value of a product can 'sun itself', safely separated from actual market forces. Insurance inflates profits so it can propagate itself. Anything that hurts the systems, helps everyone because it exists at everyones expense.
I think test strips are a good example for this argument because they have been around forever (there's very little R&D), they are cheap, and private companies are nipping at the heals of the big manufacturers. They are the diabetic bandaid. So, why does a bandaid cost so much more in the hospital system than it does over the counter? That's the simple form of the argument, right?
I think the best place to look for diabetic civil rights is in the land outside the traditional health system. Why would you pay $400.00 for a Endo appt when you can have an A1c read for $30.00 at Walgreens?
Uh, oh, system is buggy. Hope this doesn't post more than once.
To make sure it's clear, I'm not advocating accepting inferior products/treatments/solutions.
However, where a product meets industry-accepted standards, the payor has a legitimate interest -- and right -- to minimize their cost with the least expensive, accepted, solution.
Relion strips might not meet my personal standards (they don't). However, our screwed up payment model doesn't expose me to the cost differential, so of course I pay no attention to such matters when I get 150 Freestyle strips a month for a $35 copay.
Which is, of course, the entire point I've been making on this soap box. It's really easy to be demanding and picky when you're spending someone else's money. This, of course, sends costs through the roof.
John Stossel makes this point cogently with food. Imagine we all got our food via "food insurance". We pay some monthy premium, and then present our card to pay for our groceries.
Stossel makes the very good point that sales of NY Steak, Filet Mignon, etc. would increase massively, and cube steaks would pile up in the store. After all, if your "copay" at the register for meat is $10, whether its a cube steak or a filet, which steak do you think most people will get?
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I would like to pull $$ out of the hands of the health care system and try to hold them accountable to 'true' market forces. Insurance creates an oasis where the value of a product can 'sun itself', safely separated from actual market forces. Insurance inflates profits so it can propagate itself.I was with you until the end, there.
The idea that the insurance, pharma, and med device industries are just rolling in cash is simple not factually true. As such, your last assertion carries no legitimacy -- where are the excess profits?
Rather, what happens is more bureaucracy and administration fills the vaccuum, consuming the revenue. It never shows up as profit. This increased overhead is necessary to administer the increasingly byzantine rules necessary to make things "fair", combat fraud, etc.
A far better system with strong market feedback is based on the HSA model, catastrophic insurance with high deductibles, and a fully-funded FSA to cover the deductible that rolls over annually.
This was the Whole Foods model, and everyone loved it. Employer, employees, health care providers. The total cost per employee was substantially less than traditional insurance, and the insured had MORE coverage -- basically 100% coverage up to the deductible through the funded FSA.
Main difference is the individual pays the vast majority of the bills directly before the deductible is met (again, from money they are GIVEN each year). They have an incentive to be efficient -- anything left over at the end of the year rolls forward.
Costs are further saved as insurance doesn't kick in to pay anything until the HSA is exhausted. Anyone that has years of healthy living builds up a compounding balance that can get sizable. This covers costs instead of insurance.
The counter-intuitive result is this costs LESS overall than traditional insurance. Main reason is insurance carriers are not in the loop for the vast majority of transactions... Your doctor treats you, you pay on the way out. All the people, infrastructure, electricity, paperwork, etc. involved in processing a traditional claim for a few stitches, for example, is never spent on. Also, given that time is money (the old TVM), the doctors "makes more" because he's paid immediately.
Frankly, I'm dumbfounded why people of a more liberal poitical bent oppose this. I lived under just such a plan years ago when I was working at Intuit (called Definity Health), and it was the best health care plan I ever had. And the cheapest out of my pocket.
I don't know why everybody's so caught up on test strip accuracy. Maybe you can explain that to me? Is it because your running such tight control? I feel like there's less error in the band of blood sugars 80 - 100.
If there's 20% error from actual blood glucose, in any machine, then the additional error from using any particular machine feels negligible. Especially when you put sensor error on top of it. ???