With new
updates in world of bioengineering many firms are introducing various patient
friendly gadgets which help them in monitoring of health issues. But in most of
the rural areas these techniques are beyond reach. Reasons could be cost,
literacy rate, education level to monitor them, maintainace, service centers, easy
availability etc.
But a primary care physician
can judge the need of such techniques well for community. These can bring a
welcome change in community health services. He/she should try to search and
use them for improvement of rural health. Urban or rural good patient health care
should be the aim of every primary care physician.
Today I will share my experience
of one such technology came across few months back. It’s named as Continuous Glucose
Monitoring System (CGMS).This is a new technology in market for monitoring of
glycemic control of patient over period of 14 days continuously without causing
much discomfort to patient.
I got introduce to this during one
of the workshop I attended. One of my colleague there who was type I diabetic using
it smoothly to control his glycemic variables. I quite liked that so I searched
for the company that provided that in India. My main hurdle was my rural back
group .To convince marketing fellow was a task as he was bit reluctant to come
to our place, share a demo and training.
I assured him that I will personally take him to the venue and arrange
transport. Then with lot of yes/no he agreed. One more (?) Bribe I offered him was
discovery of an undiscovered market place which will help him in his promotion.
That clicked well to him I guess. :-P.
We got our demo and I soon mastered the skill.
We now have used it on more than 7 patients and it really helped them in their
treatment plan modification. My patient range was also variable /we used it in
post CABG, post angioplasty, uncontrolled diabetic patients and brittle
diabetes cases. We got excellent details from that monitoring. We also ask
patient to keep a food consumption chart to correlate readings of glucose
levels.
We document hypoglycemia unawareness, false
alarms of hypoglycemia/
Hyperglycemia,
Dawn’s phenomenon. With these variables we could modify there treatment plan and
make their life bit stress free as symptoms are gone or in control. This time
we know a concrete reason. The patient satisfaction was immense.
CGMS really document it better and
helps in monitoring of glycemic control. We even saved one patient who was
having recurrent severe hypoglycemia and need of Insulinoma workup. With careful
history, glucose monitoring and treatment adjustments things are in control, major
operative or multiple investigations and psychological stress got saved.
The only factor that hampers its
routine use in rural population of India is cost of device. But I am hopeful in
near future it will come down.
In primary care one should learn
to balance technology and its need as treatment option. We should not depend
too much on them. Clinical judgment is a priority. Additional tools like these
should be used to improve clinical outcome.
