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RACGP calls for GP permission to provide diabetes technology access
As part of a consultation process for subsidised access to continuous glucose monitoring, the college says GPs are ‘essential’ to supporting equitable access.
There has been an acceleration in the uptake of technology for the management of diabetes.
The RACGP has called out ‘unnecessarily created’ barriers which it says have been inhibiting GPs from supporting their patients gaining access to technology that can improve self-management of diabetes and, in turn, quality of life.
The statement was made as part of two submissions issued this month to the Medical Services Advisory Committee (MSAC), which is undertaking a consultation process to consider subsidising access to two continuous glucose monitors (CGMs) through the National Diabetes Service Scheme (NDSS):
In recent years there has been an acceleration in the uptake of technology for managing diabetes as an adjunct to conventional therapy.
However, CGMs are currently only subsidised for people with type 2 diabetes who hold a Department of Veterans’ Affairs (DVA) card and some people with type 1 diabetes.
Initiation of treatment is also restricted to specialised diabetes services, with GPs currently excluded from the authorised certifier group.
This is despite
the prevalence of diabetes increasing, with
11.8% of the 13.3 million clinical encounters GPs had with patients in 2019–20 being with patients with type 2 diabetes, 0.9% with type 1 diabetes and 0.8% gestational diabetes.
In its submissions, the college highlights the exclusion of GPs in the process as a significant barrier for patients, noting that cost and lack of service availability – particularly in rural and remote areas – is creating inequality in healthcare delivery.
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes who was involved in drafting the college’s submissions, told
newsGP that CGM technology provides more ‘real time feedback’ for patients and their care team when compared to finger prick testing alone.
‘The technology assists knowledge and self-management of glycaemia by giving feedback to both the person and also the health team between regular HBa1c tests that may be done on a third-monthly interval,’ he said.
‘A lot can happen between HBa1c results, so we need to know how the glucose is being managed – is it stable? Is there hypoglycaemia? And what is the effect of food and activity, etc?
‘This technology allows us to have a window into these events, whereas previously finger prick testing was used with lots of issues of reduced quality of life from multiple tests needed a day, the lack of ability and motivation to test in the night for hidden nocturnal hypoglycaemia, and absence of adherence to the regimes required to get enough clinical readings to help manage.’
While the RACGP noted evidence to support the benefits of CGMs for individuals with type 2 diabetes on insulin, it did acknowledge that patient numbers in high-quality trials were ‘generally low’ and there is a ‘lack of long-term efficiency data’.
‘It is essential to assess whether the benefits can be sustained in real-world settings outside of defined clinical trials, especially given the request for permanent ongoing funding,’ the submission reads.
In the meantime, however, the college proposes that the technology be best utilised in ‘newly initiated users whilst titrating insulin and stabilising glycaemia or when there is a clinical need such as managing recurrent hypoglycaemia’ in line with NDSS guidelines for self-monitoring of blood glucose.
If the new technologies are to be successfully implemented, the RACGP is clear in its stance that changes in healthcare delivery will be necessary, starting with acknowledgement of the
central role GPs play in diabetes management.
‘GPs are central to the process as insulin initiation and management of type 2 diabetes falls well within scope of general practice,’ the submissions read.
‘It is essential that GPs be allowed to provide access to this technology without requiring endocrinologist approval.’
Dr Deed agrees and says a well-educated GP and primary care team are ‘ideally situated’ to support a patient to utilise the technology adequately.
‘There were
almost 1.2 million people living with type 2 diabetes in Australia in 2021 and these people are mainly managed in general practice without the need to see any specialist care,’ he said.
‘Requiring them to see a specialist health professional to get access to this technology is an impost on time and resources.’
If the MSAC heeds the RACGPs’ advice, the college is recommending that appropriate educational support be developed for GPs. However, it made clear that it does not support any mandate for GPs to complete additional educational requirements.
The college’s justification for this is that it would only ‘increase barriers’ to patients accessing appropriate diabetes services.
While the RACGP notes that developing these materials may result in additional short-term costs, it said the alternative of removing patients from the GP setting would ‘negatively impact’ healthcare economics, patient satisfaction and accessibility.
‘As specialist generalists, GPs play a fundamental role in the prevention, diagnosis, and management of diabetes across the life spectrum of this disease, working with patients at every stage of their healthcare,’ the submission reads.
‘General practice is, therefore, central to a health system supporting people with diabetes.’
The MSAC is expected to release its consultation findings in 2025.
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