Sunday, 16 January 2011 | by Mike K

Accu-Chek Aviva Expert Review - One month in

Well here goes. This could be a long one...

I was offered a 'trial' of the Accu-Chek Aviva Expert blood glucose monitor early last year, but for one reason and another it never happened. The idea, I think, was for Roche to get some feedback from real hands-on users as to how it worked. As I sit typing this I really wish I had had a chance to stick my oar in, though to be honest, by the time the trial was being offered I suspect the production unit was not going to change much, if at all.

Then a few months ago the DSN who had asked me about the trial asked if I was still interested as she had a few handsets that she was able to give away. Another thing to mention at the start of the review is that I don't really have a very wide range of experience of using different monitors day to day. I've always used Roche units and always been happy enough with them. If you have always loved another brand and/or hated Roche units you will have to bear that in mind as you read my opinions. Before being offered the Expert I was tempted by the sleek tininess of the Contour USB, but was intrigued by the offer of bolus advice and eagerly took up the offer of the Expert.

In a nutshell
The Expert handset is apparently based on the system which offers bolus calculations for their pumps, though it seems to have been simplified somewhat, it lacks Bluetooth connectivity and those exotic pumpy bolus delivery patterns. The basic idea is that you can test your BG, input the amount of carbs you are about to eat and the meter will then suggest a bolus based on the parameters you have set for the time of day (target range, insulin sensitivity, insulin:carbohydrate ratio, duration, level of activity and so on). These are careful calculations (read wild guesses) that insulin-using diabetics have to make several times each day. Often it feels more 'art' than 'science' and I know for my own part that there is often a fair amount of gut instinct that goes into a bolus calculation. I was less than sure that a bit of software would be able to read the ebb and flow of my days in the same way. Quite frankly it didn't seem likely.

But as walked to the appointment to be shown how to set up and use the meter, it became clear to me how much I was beginning to want it to work. To be able to hand over the hassle of all those little bits of information, ratios, correction factors to a little gizmo that would do it all for me.

The meter itself
The Expert is not dissimilar in size to my old Accu-Chek Aviva. A little wider, a little squarer, a little chunkier, a little thicker. Something like 55mm x 94mm x 25mm. For those who have had Roche meters before it will fit (along with a tub of strips and the excellent Multi-clix finger-stabber) in the familiar sized zip-up black pouch. It's a smart black and has rather more in the way of buttons on the front than other meters I've owned. The buttons themselves are those little rubbery affairs with a pleasing 'clu-dunk' action. One early annoyance was the location of the on/off button. Since this has been placed on the front of the meter it is all too easy to turn the unit on when just grabbing the zipped pouch.

This is the first meter I've owned with a colour screen. Ooooh! Don't get your hopes up though, the screen is smallish at around 34mm x 28mm and only has the resolution of mobile screens from 5-10 years ago. While in the most part this is perfectly adequate it does make some of the graphs the handset can offer rather less than clear. I'd heard murmerings about battery life before I got my hands on the Expert, and I haven't had it long enough to comment, but I would say that the box of goodies supplied with the meter came with two spare sets of batteries (3x AAA) and once you register with Roche they will send you replacement batteries on request.

When you first turn the unit on you are walked through a fairly lengthy but admirably simple set-up procedure where you define everything from time and date, high/hypo levels and expected rapid-acting insulin duration to target BGs, insulin sensitivity and carb ratios across a number of editable 'time blocks' through the day.

Testing itself makes use of the familiar Aviva test strips which require a code-chip every time you start a new box. Some might find this an annoyance, but I don't find it slows me down at all. Insert the strip (which turns the meter on even if you've 'locked' the buttons) and the brief pause while it prompts you to check the number on the pot of strips is just long enough to get a drop of blood going from your calloused fingers. The strips only need a relatively small drop of blood (0.6 microlitre) and handily if your first attempt is a little on the small side, you get the chance to squeeze out a little more blood and reapply before the meter throws an error message. Results are delivered in around 5 seconds.

Reports and data
Over the previous 5 months I had been carefully logging insulin, carbs, exercise and all manner of other details using the brilliant DiabetesDiary for iPhone/iPod Touch. All the averages, stats and pretty graphs a diabetic could wish for. I suppose this meant I was used to inputting data at every meal and I was pleasantly surprised at the ease of entry of details into the Expert. Unfortunately, although the Expert will record all the facts, there is no method by which you can add any notes or comments to records. Even a system whereby you could predefine your own 'comment list' by some lengthy letter-by-letter process and then attach notes to entries such as 'Gym day', 'Underestimated meal carbs', 'Fake hypo' or whatever via the Expert's click-and-choose menu system would make the results stored on the meter much easier to analyse at a later date. Which brings me to another gripe... I have no idea why meter manufacturers (and Roche in particular) are so obsessed with Infrared as a means of data-export. The Expert is compatible with the 360° software package, but I don't really want to buy-in to a whole expensive suite of data-management tools and infrared gizmo. I just want to be able to export and print a month or two's results and take them to my appointments. A simple USB port/cable and CSV file export would be fine thanks. And even if I did fancy the 360° system, I've just upgraded my PC and it won't currently run on Windows 7 so that's a non-starter. Unfortunately what this means is that the data logged in the Expert is trapped there and the screen is really just not up to the job of reviewing the information in anything more than a general overview way. The graphs and reports are just too tiny to be read with much clarity, and table views which offer just 5 lines of data mean much scrolling is required to look back over recent results. The graphs are particularly frustrating - there's a dotted horizontal line to show 'hypo' but no other lateral reference points. A line for 'hyper' and some shading to show the desired BG range(s) over the time period would have made them much more worthwhile, even at small sizes.

There are a bunch of charts, graphs and tables available which do give you a good overview of your recent control. My particular favourite is the 'Target' pie chart which instantly shows you the proportion of results high, in-range, below-range and hypo. Even this though could do with a tweak. The Expert allows you to set a range and a hyper and hypo warning level. This means that you can grade your results to identify low level ups and downs as different from more serious hypers/hypos. Inexplicably though the 'Target' charts do not differentiate between high and hyper.

Reminders
One area that I've not really explored is the comprehensive set of reminders and alerts which can be set to beep or vibrate at you. Reminders to test, prompts to retest after a high or low reading, waking you up for overnight testing, even just to use the expert as your alarm clock!

When it works well
The fact that I picked up my Expert a few days before Christmas might be seen as unfortunate timing. It's not the easiest time of year to get your carbs and doses right, and the first week or two were decidedly difficult, not least because my first attempt at setting up appropriate targets, sensitivities and ratios proved a little off, and I was a little too ready to take the Expert's advice even when I suspected it wasn't quite right. For seven days over the festive break though, when work seemed a million miles away, meals could be taken at leisure with careful bolus-eating delays and one day was much like another the expert performed spectacularly well. I had almost no hypos and something like 75-80% of readings were in the 4-9mmol/L range. I began to believe this could be the start of something really good.

Bolus advice
I won't go into all the complexities of the calculation system here (lest you lose the will to live) but essentially the Expert takes the mid-point of your target range and will always seek to pull or push your BGs toward that. If you come into a meal on the low side it will knock-off an amount of insulin, based on the figure you have given for BG change per unit, along with any plus or minus fractions allowed for exercise, stress, illness etc. Conversely, if you get a meal hopelessly wrong it will suggest a correction dose to bring you back in-range. There are safeguards in place that keep track of insulin duration and the timelag between correction doses and their effect being evident to help prevent over-correction. And of course the Expert is only making suggestions. You can easily override at every stage. One nice feature is the way it displays any plus or minus correction-factors involved in the advice, along with any rounding up or down of the final dose (to the whole or fractional units you have defined). This means that you can see whether the 6u bolus suggestion was based on 5.5u or 5.9u and also how much was down to the Expert wanting to get you from say, 4.5mmol/L to the midpoint of your target range.

A few set-up oddities
Once you have the thing basically set-up and are looking to fine tune it, a few issues begin to emerge. Insulin ratio is only available in whole units. While this is largely satisfactory, for higher carb meals being able to specify to a decimal place would be an advantage. The 'offset time' setting (the expected delay following an injection for BG levels to begin to fall) can be set as no less than 45 minutes. There seems to be no reason for this, and with the profile of some analogue insulins this seems less than ideal. Additionally only one 'offset time' can be defined, while my own experience suggests that I would expect a different delay at different times of the day. 'Active insulin' is another anomaly... the handbook suggests this shows 'bolus insulin that has been given to lower your blood glucose, but has not yet been fully used'. You might expect this to be tracking your whole meal bolus, plus any additional correction factor, but in fact it ignores any part of your dose which is supposed to be dealing with carbs and only reports on correction doses. If you want the Expert to keep tabs on your total insulin-on-board you need to back out of the bolus advice screen and then add the bolus in manually. A simple 'include meal bolus in Active Insulin figure' checkbox would have helped.

Final thoughts
Overall I think I'd have to say I think the Expert is pretty good. Strangely that is a real shame, because it could have been brilliant. There is nothing like it on the market for us folks on MDI and a little more polish could have made it something really special. In a week where one day was very much like the next it gave me excellent results. But in a working week where every day is different it is still struggling. It feels like there are just one too many niggles and concerns. The only reason you would want this meter is if you wanted something to give you more than just a simple record of BGs. I like being able to add data, but I'm not a machine, sometimes I make a mistake. I'd like to be able to delete entries which are wrong, or change times and dates where I make mistakes. To forbid me from doing so because you think I'll just lie to my healthcare team is ridiculous - if I want to deceive them I just won't show them actual results. Sometimes I'll click OK then change my mind about the amount of carbs, or dose I'll take. I'd like my meter to give me enough respect to allow me to log what actually happened. You can modify some records, but not enough and not completely enough. The bolus advice is often pretty good, but it falls down if I make an error in carb counting, and makes no attempt to track the absorption of any carbs, trusting the insulin to deal with them.

Having said all of that I'm glad I have one and will be persevering for the next few months up to my annual review to see if I can tweak the settings still further and repeat that 'perfect' week.

Final score: 4 out of 5.

UPDATE: Having re-read through this a day after posting I realise how nit-picky and negative it sounds. The truth is I really like the Expert, and careful tweaking of its parameters is getting it to provide more consistently effective bolus advice. I think the gloomy cloud over the review is down to the frustration I feel that the unit is only 'Good' when really without very much alteration it could be 'Great'.

Oh one other thing... I linked to this post on a forum and Rob, another Expert user pointed out a way to set fractional insulin ratios. It's not really a problem which affects my ratios, but if your ratio is, say, 1u:7.5g carbs and you have a larger meal containing perhaps 120g of CHO, settings in whole units would only permit a bolus suggestion of 17u (1:7) or 15u (1:8). Rob's clever suggestion is to set the ratio using a higher carb value, so 1:7.5 becomes 10u:75g CHO on the Expert. Ingenious!

On reflection I've pushed the final review score up to '4' from '3.5'. It's still early days. I may well post another update in a month or two after a little more experimentation.

FOLLOW UP: Learning to love my Accu-Chek Expert

29 comments:

Anonymous said...

(second try - I found this blog from Diabetessupport)
I loved this review and will try to get one of these meters if I can find one (or can afford!)Will you still use the DiabetesDiary for your iPod, which could be an alternative for me.

Mike said...

Thanks for your feedback.

I think the answer is probably yes, but only occasionally. I have my 30,000 jab service (annual review) coming up in April and had already planned to do a bit of double-entry over March, recording information both in the Expert for the bolus suggestions and in DiabetesDiary for printouts to take with me. It's a bit of a nuisance and perhaps I wouldn't bother if I could get some info out of the Expert, but because of the size and resolution of the screen, ability to quickly scroll through results, check comments on particular entries as well as some of the easier to read averages/graphs available, I do find analysis of information easier with DiabetesDiary.

Anonymous said...

I wouldn't touch one of these with a barge pole. After a 1 month trial, using this versus my own well-tried and tested One Touch UltraEasy, and doing 2-metre comparisons for every test, it constantly gave readings around 1.5 - 2.0 mmol/l higher. Obviously this will keep you further away from hypoglycaemia, but into much poorer overall control.

Avoid it. It's over-engineered and under-designed, heavy, clunky, and slow. It is to blood glucose testing what SatNav is to common sense.

Mike said...

Thanks for your comment.

From what I've read it seems not uncommon for different meter systems to give different results. But then each meter will have it's own margin of error of 10-15%. And of course there's no guarantee the blood in your finger is the same level as the blood in your brain! I'm nearly two months in now, and I'm still tweaking settings for maximum effectiveness.

I may well post an follow-up to this review in a while

Dave said...

After asking today I've got one with my name on it but my DSN says she has to be trained to be able to give me the training to use it. Session booked for a week Friday to get my hands on it :)

Dave said...

Flaw found.

Whilst having a yoyo day at the weekend I got hyper and bolussed a correction. Feeling a bit (now what's the word my mum always used to use, ah yes) 'waffy' I retested about 3 hrs 40 minutes later. Hypo. Ducking fiabetes.

Anyway, fruit pastilles consumed. 15 mins later the meter flashed up a warning telling me to retest as I was hypo recently. Test done - a respectable 4.8. Turned meter off and then less than a minute later it flashes up asking me to retest to make sure I still wasn't hyper!

Some logic is required to cancel testing reminders if a test has occured in the meantime.

Mike said...

Thanks for the update Dave. I've never actually used any of those auto-reminder functions so this is not something I have seen working (or not, as you have found!)

Anonymous said...

Which retailers stock this in UK? I can't find it anywhere online. Any suggestions would be great, thanks!

Mike said...

Hi Anon

As far as I am aware the handset is not available for purchase over the counter. Because of the nature of the advice it is able to give it is important that anyone using the Expert is properly trained to set the meter up correctly and configure their individual settings and levels in agreement with their healthcare team. You would need to speak to your Diabetes Specialist Nurse or clinic who will be able to advise you on suitability and availability in your area.

Anonymous said...

Many thanks. My DSN has recommended a free online course for carb counting and how to workout correction factors etc for myself. Hopefully it will be as easy to get a meter ordered. In case anyone is interest the course is: http://www.bdec-e-learning.com/register.asp

Mike said...

We've linked that course in the menu too!

Paul said...

My son (11) has been using the Aviva Combo pump and meter for 18 months and it has been a vast improvement for his control over basal/bolus multi-injections. My daughter (13) was recently diagnosed Type 1 too, and she has the Aviva Expert.

The bolus advice system is not something that you setup and forget, by analysing the readings over days and weeks it may be necessary to tweak settings such as carb ratios to be different at each meal period. Also, if health corrections to insulin aren't applied (e.g. if you don't know that you are coming done with a cold) then that can affect glucose too.

The pump obviously does fine-tuning of basal delivery. But mostly the two meters are the same, the Combo has an extra Meter menu item for direct meter control.

These meters and pumps all work with Roche's Smart PIX USB device. Transfer the data via infra red and the Smart PIX provides web based reporting. It work on PC and Mac [though a bit clunky on the Mac since to create reports the Smart PIX ejects itself and causes the Mac to display alerts that the device was removed incorrectly]. The Smart PIX generates text based XML files too.

All in all these meters provide a lot more freedom to my kids who will do carb counting and then let the meter suggest the bolus. There is no need to carry tables of corrections and carb ratios. But the iPhone and pocket versions of Carbs&Cals do travel with us.

Mike said...

Thanks Paul. Great to hear you are harnessing the power of technology to help your kids manage their diabetes better. Parents of CWD (especially with more than one diagnosed child) are all complete heroes in my book.

Paul said...

We have logged the data on computer since very early on after seeing that paper logbooks didn't have enough space or slots to fully capture everything we wanted. The best practice was to record as much as possible and then that data can be reviewed in many ways - different consultants/doctors preferred data in different views.

The result was that they could clearly see trends and get adjustments sorted sooner. Actually having the data and being able to see trends was a good motivation tool for us. When you think "it's all going wrong" by looking at a trend of glucose readings by time during the day over, say, the last few week you might then see that on average it has been pretty good and that it's only just before dinner that highs/lows have happened.

The data then backed up the move to basal/bolus from the inappropriate mixtard. It also was used by the consultant to back the medical case to move my son onto the pump.

My son can't remember a time that he wasn't injecting, but I can and having to do the first one in hospital through welled-up eyes is something I won't forget. But after time you realise that the child that you had is still here and diabetes is only one facet of them.

Mike said...

Absolutely! I also *really* like the Expert's SD display which helps to show how 'spread out' the readings are that give the averages. Averages on their own can be a bit misleading.

Though they are a bit on the small side I also like the graphs which show the range of readings by day/week/month etc which again can help you spot tricky days or time periods. Having that sort of analysis on the meter itself is very handy.

Anonymous said...

Wouldn't it be a good idea if between us we could design the perfect system? I follow the DAFNE regime and use the one touch ultra smart meter. The meter has been around for a few years now, it great for recording and uploading data to a PC as only a cheap usb cable and free downloadable software is needed before you are using a full range of reports. It pre-dates this new concept of bolus advice. Why can’t companies like one touch or Roche design a meter around the widely used DAFNE system and using things like usb for ease of use and bolus advice? Just a little joined-up thinking could turn a later version of the ultra smart into something very special

Anonymous said...

A good review my daughter just got hers yesterday so we shall see how things go, although at age seven she loves the looks of it - similar to a phone and the snazzy plastic covers she got with it.

Just one thing - in the review you said it doesn't calculate in half units - ours does but it needs to be set up.

We had been using track3 for the iPhone it will be interesting to see how this compares. The only down side I can see t the moment is not being able to make notes, battery life and method used to download data.

Mike said...

Don't worry about battery life - just get Roche to send you replacements (only takes a quick registration). Perhaps I should have made more of the option to get bolus advice in half units - the Memoir pen I was using at the time only gave half units. Hope you get one well with it :) stick at it if it takes a while to get it set up properly

Ian.R said...

I am hoping to get one of these meters soon, Currently using one touch easy and insulin pro iphone app. One question I have is... do you have to enter the carb value at time of taking reading? for example if you are not sure of the carbs untill you have finished your meal, I am used to counting carbs as I am eating and may/may not decide to have desert, Totalling up carbs then injecting afterwards. Knowing what carbs you are "about to have" is ok if you are eating at home/preparing your own meal, but if not you don't really know the value untill it's in front of you. Would be useful if the carb value can be entered separately, is this possible on the expert? Hope this makes sense.

Mike said...

Hi Ian, two ways the Expert would allow you to do that. The first would be not to take the reading until you are ready (ie at pudding time in your example). To use the bolus advice you need to act within a few minutes of taking a reading if I remember right - its been a few months now since I used the Expert in earnest. The second (and my preferred approach) would be to split the dose in two. Leaving everything until after meant the main part of the meal had too much of a head start for me. I would test BG and calculate for the meal, then test again and add an extra sliver if I went ahead with pudding (or ate more than expected). There are nifty calculations for doses very close together that aim to avoid too much overlap, but if you are particularly sensitive to dose stacking you might need to delay the second bolus until perhaps an hour or two after the first. You can manually enter a bolus you make at any time, of course, but to get access to the bolus wizard you need to take a BG reading. Hope that makes some kind of sense!

Anonymous said...

Hi Mike,
Thanks for the review, really helpful. I've just got one of these and using for less than 24 hours so far. My DSN said that Roche may not charge me for the 360 software if I called and haggled... I didn't manage to get a free copy so I called my DSN back and she got in touch with her Roche rep who provided a free copy of the 360 software the same day. I am due to pick it up tomorrow. Maybe your DSN has a similar agreement with her rep and will do the same for you.

Mike said...

Thanks Anon, I did contact Roche to ask about 360 (I gather this has now been patched for Windows 7), but stuck by their 'You have to buy it' line. Sounds like you have a keeper of a DSN there!

Anonymous said...

Hi there Mike,

Can you please tell me if it possible to enter a BG manually with the Expert system (i.e one taken on another meter) and still use the bolus wizard? I am considering getting the Expert but only if it is possible to do this and I can't find the info anywhere online.

I am only two months in from diagnosis so I won't be elgible for a pump for a while but I am really struggling with all the maths I have to do now and think the Expert's bolus advice would really make my life easier.

The trouble is I don't want to use the Aviva meter for testing as I really love my Freestyle Lite. The sample size is only 0.3 microlitres, it's no coding and has a light on the test strip port, which are all features I just won't give up.

I'd really appreciate it if you could let me know before I talk to my care team about this.

Thanks!

Mike said...

Hi Anon

I've had a look and (perhaps unsurprisingly) there does not seem to be any way of manually adding BG data. The 'add data' screen allows the addition of carbs/health/bolus/basal data at a specified date/time but there is no BG area, and no way of accessing the bolus wizard.

There is another smart meter, the Insulinx, but I don't know (and kinda doubt) that the facility might be offered by that. Have you looked into bolus advice apps available on smartphones? There are certainly ones available for the iPhone/iPod Touch and I think there are apps for Android phones too. Might be another way of getting the same number-crunching support? Good luck with your search! M

Anonymous said...

Hi Mike,

Thanks for getting back to me. I thought after that was a bit of a dumb question because of course, the meter companies make the bulk of their profit from the strips. Still, good to know.

I've had a look into the Insulinx. Thanks, I had not heard of it. There's very little info on the Abbott site but from what I can gather it is their version of the Expert and I'm quite tempted to look into it.

The Insulinx would probably have the smaller sample and other features I'm looking for but on the other hand, the Expert looks to have a few more features and the screen is way better. I'm also partial to the Multiclix and I've just read about the new chip that is supposed to get rid of coding on the Accu-Chek meters.

I'm definitely going to ask my team about the Insulinx but the more I read your review and others and watch on Youtube, the more I think I should give the Expert a fair try. Maybe I'll ask to try both. I know I said I'd never switch but we'll see. The blood sample is my biggest worry but I've never used any other strips so I don't know how noticeable the difference is. My care team love Accu-Chek stuff so I'm sure they would arrange a trial.

Alas, my phone is still an old brick. I should upgrade but my texting skills are non-existent and the newer models would probably make it worse. I'm all fingers and thumbs when I have to text on the team phone at work.

Thanks for your help and the detailed reviews, lots to think about.

Mike said...

Hi again

I hope you get on well with whatever meter you try. I can't say I've noticed much 'actual' difference in obtaining enough of a sample to operate any meter I've used. I always seem to need the same size drop on my finger, and there is usually some left over after the sample has been taken. I am a *Big Fan* of the multiclix. The best lancing device I have ever used by far.

As to the light port for night testing, I suppose you could keep some strips back for overnight tests. We all realise that different meters work best when used on their own (just like its best to stick to either imperial or metric in a recipe) but for a specific functionality like that I can see an argument for keeping a pot of strips for your old meter. If it was me I'd just do half a pot's worth of double tests to get a feel for an average difference between expected results and then remember that whenever using the old meter (I did the same when changing to the Contour which works with Artoo). You are bound to see differences,of course, but it helps to know that one tends to read 0.3mmol/L higher (or lower) than the other. Good luck with it!

Anonymous said...

Hi Again Mike,

Thanks for another informative reply. I hope to be trialing the Expert in a few weeks! My care team were quite positive about it and are going to start the process. They just want me to have a few more weeks experience at calculating on my own under my belt as I'm still new to this.

They put my mind at ease about the sample size and its true I normally have blood left over with the Lite anyway. It's really hard to just draw 0.3 microlitres. I've always struggled to maintain healthy iron levels which is why it's a worry to me now I'm making myself bleed often but my nurse said much the same that I wouldn't probably need to draw any more than I already do.

I am fond of the Multiclix myself. (Although I love the Lite its lancing device really hurts so I don't use it.) I tried the Delica and its 33g lancets are so gentle but I could only get them online and they were fiddly to change. The Multiclix drum is much easier and it's not more painful despite the larger lancets, though it makes a bit more noise. On the whole, I prefer it.

I'll see how the night checks go when I get my trial Expert. The light of the screen might be enough especially since the blood goes on the end of the strips not the side. With a bit of practice I might be ok. If not, I'll just stick to the Freestyle at night as you suggest.

Thanks!

Paul said...

Just an update to confirm that the Aviva Expert (and Combo, plus maybe other Accu-Chek meters) have changed to be code free. All the new test strips come with a new black code chip that doesn't have to be changed every time you change tubs.

Sam NiceDiabetes said...

Thanks for the tips

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