What To Look For In A Glucometer

I received a question some time ago about which glucometer I would recommend, if any, and I thought I would put down some notes about this, since I do have opinions, but I also know full well that I’m not the right person to recommend medical devices in the first place.

So just we’re clear, I’m not a medical professional, and I can only suggest as for what to look for when choosing a blood sugar meter device. If your GP or diabetologist is recommending one in particular over others, I would recommend you follow their suggestion over mine.

So first of all, what are we talking about? I’m going to be focusing on blood glucometers exclusively, because the choice within CGMs (Continuous Glucose Meters) and “flash” meter solutions (such as the FreeStyle Libre) are more limited, and I have even less experience on those. I also found out of personal experience, together with talking with a number of other CGM users, that those tend to be a lot more temperamental and personal choices.

Blood glucometers, as the name implies, work by measuring the sugar in the blood by putting a drop of blood (usually taken by pricking a finger) onto a chemically reactive “strip” (with the exception of one device to my knowledge). I have over the years “reviewed” a number of meters on this blog, simply because I end up getting my hands on them out of hobby nowadays, to reverse engineer and implement support (when feasible) in my open source tooling.

Let me repeat: I do not have the technical expertise to judge the clinical effectiveness of glucometers. I do know that most of them have a wide margin on their readings, to the point that you may have noticed me annoyed at the difference readings on a recent stream. Most meters provide details about their accuracy in the paperwork, and they assert you can use certain calibration solution to verify that your particular device satisfied that calibration. Unfortunately when I have been looking at this in the past I couldn’t figure out whether there is an universal solution that could be used to compare the readings of the same exact concentration across different meters.

So, if I wasn’t using the Libre, what glucometer would I be using, and why? Most likely I’d still be using the Accu-Chek Mobile. As far as I am aware it’s still the only model of meter that uses a cartridge system rather than strips, and when going out for dinner or coffee, or being in the office, it’s nice to have the option to just check your blood sugar without having to worry about getting blood all over the place, or having to find where to throw the now-used strip. While the device is not the smallest glucometer out there, the carrying case does still make for a much more compact solution than most of the alternatives used, and the USB “thumbdrive” with data and graphs make it very easy to access with most devices. I have not tried the Bluetooth integration kit, though I did order one, but I guess that was needed for the increasing amount of people who do not use a “computer” daily, but does have access to a smartphone.

But this is just my choice, obviously. If you live in a country that does not provide to you the strips for free (or you don’t have an official diagnosis for which they would provide them for free), then the cost of the supplies is likely the main significant factor. Many of the manufacturers appear to have taken to the “razor and blades” approach of giving out the meters for free, or nearly free, but charging you (or your healthcare system) heavily for the strips. So it might be worth looking at the price of strips in your country to figure out on the long term what’s the cost of using a certain meter or another.

This is my best guess on why people appear to be finding my reviews of Chinese glucometers: to the best of my understanding there’s a number of countries, including Russia, where meters and strips are paid out of pocket, and so people turn to AliExpress, because there’s enough supply — most Chinese meters appear to use the same strips, and sellers undercut each other all the time, particularly when the strips are about to expire.

If price and availability are not an issue, and neither is the cartridge vs strips, then it continues down the road of features. Is the meter going to be used by an older person with eyesight issue? Look for a very big display. Is it going to be used by someone who has trouble with at a glance estimation of what is okay and isn’t (well noting that this category is pretty much transversal to age groups and education)? Look for a colour display that includes Green/Yellow/Red indicators, possibly one where the thresholds are configurable.

Some of the features also depend on what your doctors’ take on technology is. My diabetologist in Dublin didn’t have any diabetes management system for me to upload readings to, so I settled with running the exports with whichever software and sending it over as a PDF, while my new support team here in London uses Abbott’s LibreView. Am I completely comfortable turning to a cloud solution? No. But in the grand scheme of things it’s a tradeoff that works well for me, particularly after a year of Covid-19 pandemic, during which showing up at the hospital just to hand off my meter to be downloaded into the system would not have been a fun experience.

So if your medical team has set up a specific software for you to upload your data to, you probably want to choose a compatible meter. And that might mean either one that has PC connectivity so you can download it with a specific client, or one that has Bluetooth connectivity so that you can download it with your phone. With additional complications for macOS users and pretty much zero support for Linux users outside of devices supported by my glucometerutils, Tidepool or other similar solutions.

Different software also has different “analytics” of readings, with averages before and after meals and bucketed by time of day. Honestly, I don’t think I ever had enough useful information for a blood meter to build significant statistics out of it, but if that’s your cup of tea, that might be a good feature to choose your meter from (as long as you’re not using glucometerutils in which case just get any meter and build the analytics out of it).

Again depending heavily on who’s going to be using it, it’s important to take into consideration the physical size and a few of the practicalities of using a blood meter. Smaller meters work great if you have small hands, but they would be too fiddly to operate for someone with large, not nimbly hands. That’s why a lot of the models aimed at older people (with sound, large display, etc) are often designed to be big and with large and mushy buttons, rather than small and clicky. The same goes for strips: as I noted on the GlucoMen Areo review, Menarini did a very nice job with fairly large strips that are easier to handle, compared to, say, the tiny strips used by FreeStyle or OneTouch. But even with tiny strips, the meter can help with making it easier to handle; both of the Chinese meters I have reviewed have a lever to eject the strip directly into the trash, rather than having to take it out with your fingers — while I suspect this may just be cultural, it’s definitely a useful feature to have for those who are squeamish about handling blooded strips.

I would say that it’s pretty much impossible to have a meter fit all of the best characteristics, because a lot of those are subjective: I have nimble fingers, good numeracy, and a few reserves with sharing my data with unknown cloud providers, but with a medical team that does indeed use diabetes management systems. So if I had to be looking for a new meter (rather than the Libre) right now, I would probably be looking for a compact meter, that can be downloaded either with an application that exports directly to my doctors’, or with one that can generate a file I can email them, and the Accu-Chek still fits the bill: it does not have colourful display to tell me whether something is in range or not, and its buttons are clicky and not too wide, but it’s a tradeoff that works for me.

This should also probably explain why I talk about the stuff I talk about when I write my glucometers reviews: it’s all about how the device feels, what features it has, and how well it works to do what you want. Some of the models are more intuitive than others, and some have tradeoffs that don’t work for me, but I can see where they came from. I cannot compare the accuracy, since I don’t have the training to do so, but I can compare the rest of the features, and that’s what I focus on: it’s what most people will do anyway.

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