Glucose monitoring advances mean ‘real expansion in clinical utility’

‘Technology like this has really underpinned my belief that self-management of diabetes should be promoted. It really allows people to better understand their diabetes, and link management changes to that understanding of it.’
 
That is Dr Gary Deed, Chair of the RACGP Specific Interest Diabetes network, talking about continuous glucose monitors (CGMs).
 
He told newsGP the devices have proven their worth in managing his own type 1 diabetes.
 
With the Federal Government recently moving to expand subsided access to a related flash glucose monitoring device, Dr Deed said more patients need to be aware of the benefits.
 
‘It lets me self-manage my diabetes more effectively and more proactively,’ he said. ‘It allows the user, with education, to be more mindful and aware of their glucose targets and goals, and to be aware of variance from those goals.’
 
Dr Deed uses his CGM for everything from preventing hypoglycaemia in his sleep to checking the impact of a specific type of food.
 
‘It allows me to be aware of [my glucose levels] without having to get up in the night and do a finger prick,’ he said. ‘It’s less messy and much simpler.
 
‘I can detect patterns to see if they are trending high or low, so I can anticipate a problem before it occurs, or see hidden patterns I wasn’t aware of. That lets you adjust your medications or lifestyle or diet.
 
‘I can see how different foods or meals affect my glucose levels, as well as physical activity. It really is like painting a picture, with the ability to see the whole picture rather than piecemeal.
 
‘Before this, the finger prick was almost a drama to do it. Now it makes testing easier and the presentation of information instant in a visual way. That, with education, promotes quality self-management.
 
‘It’s really to identify problems and address management of the problem.’
 
Dr Deed said CGMs help patients be more precise in their self-management, with particular benefits in avoiding hypoglycaemia, as well as helping those having trouble with glucose control to pinpoint the issue, and women with diabetes planning a pregnancy.
 
Most devices have alarms to tell users if their glucose is rising or falling too quickly.
 
CGM devices stream data to a reader or smartphone app from a sensor attached to the skin, with some able to send data direct to a doctor.
 
‘[The sensor] is minimal and doesn’t interrupt normal social functions. It can be hidden under clothing,’ Dr Deed said.
 
A filament from the sensor penetrates the skin and sits in interstitial fluid. That makes it less painful, but also incurs a delay of up to 20 minutes behind the blood glucose level.
 
‘That makes the trend arrows very important – you can see if you’re trending up or down. Part of education is to make users aware of this,’ he said.
 
‘This is much more patient-friendly than finger pricks.’
 
CGMs have been available for several years, with the technology evolving rapidly. The devices have shrunk and the utility of the associated apps has expanded. Some can communicate directly with insulin pumps to adjust doses.
 
‘In the last two years, there has been a real expansion in clinical utility,’ Dr Deed said.
 
In February, the Government moved to expand eligibility for fully subsidised access to the FreeStyle Libre flash glucose monitoring device, making it available to 58,000 people with type 1 diabetes under their CGM Initiative.
 
Flash glucose monitoring devices are stripped-back versions of CGMs, requiring users to scan the sensor with a reader or smartphone, and without the ability to trigger an alert if levels are too low or high. These devices also do not connect to insulin pumps.           
 
The key change was removing the ‘high clinical need’ requirement for people with type 1 diabetes over 21 years old who have concessional status.
 
Dr Deed said making these devices more accessible is ‘a leap forwards’, particularly for vulnerable groups who may not have been able to use the technology due to the cost.
 
Glucose monitoring systems can cost $50 to $100 a week, or more.
 
‘We’re now looking at a hurdle of concessional status,’ Dr Deed said. ‘High clinical need required interpretation, and some people felt they might have been inadvertently missing out on availability. This is more equitable.’
 
But there will still be patients who cannot afford the technology and are not eligible.
 
‘We will still advocate to increase eligibility over time. This is a staggered improvement,’ Dr Deed said.
 
Details of subsidised devices are available at the National Diabetes Services Scheme website.
 
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