Glucose monitoring systems are space technology, say experts pleased with the announcement of reimbursement for adult blood glucose monitoring (FGM) systems. However, for patients who are unaware of hypoglycemia, real-time continuous glucose monitoring (CGM) systems are the best solution. Deputy Minister Milkowski talks about ongoing work to make them accessible to patients.
The situation of patients with diabetes mellitus in Poland is improving, which can be seen from the compensation lists, which include new drugs for this group of patients (since September, a much larger group of patients have received access to floins and GLP-1 analogues). However, it is not only drugs that affect the effectiveness of diabetes management: many studies and clinical practice show that effective glycemic monitoring tools are almost as important as drugs. In this regard, there has been a revolution in recent years, and traditional glucometers are gradually becoming obsolete.
FGM and CGM, i.e. necessary individualization of treatment
prof. Malgorzata Myslivec, Head of the Department of Pediatrics, Diabetology and Endocrinology at the Medical University of Gdansk, who has been treating children and adolescents with type 1 diabetes for many years, has no doubt that glycemic monitoring systems are a breakthrough in civilization. There are basically two types. The first is a blood glucose monitoring (FGM) system where the patient must move the receiver closer to the sensor to get a result. - He sees not only the measurement point, but also the trends in blood glucose levels. “The patient knows exactly how his sugar level rises or falls, for example, after eating or starting physical activity, he can adequately make therapeutic decisions,” said Prof. Fighter.
She noted that patients on intensive insulin therapy benefit greatly from the use of this system, but it is not optimal for patients with unconscious hypoglycemia. - They have no predictors of hypoglycemia, so they cannot currently measure their glucose levels. They are also at risk of hypoglycemia at night. Another problem is that a patient who has experienced an episode of hypoglycemia is afraid that it will not happen again, so he tries to maintain a higher level of glucose in the blood, which worsens diabetes control, - emphasized prof. Fighter. Thus, real-time continuous monitoring systems are much more effective for patients with type 1 diabetes and unawareness of hypoglycemia. They constantly monitor your blood glucose levels, alerting you to impending hypoglycemia and stopping your insulin delivery if necessary.
Both types of systems provide reimbursement for children and adolescents, but reimbursement for FGM ends at age 18 and for MCM after age 26. The draft regulation, published in July, provides for the extension of reimbursement for FGM systems for adults as well. However, experts and patients note that a group of patients with type 1 diabetes and unawareness of hypoglycemia, especially those using personal insulin pumps, should still be able to use GPS. - Our experience and large international studies have shown that the CGM system in combination with an individual insulin pump prevents 100% of severe hypoglycemia. Compensation of these systems for people over 26 years of age will significantly improve diabetes control, and in patients with hypoglycemia unawareness, will prevent severe episodes of hypoglycemia, - emphasized prof. Fighter.
Dangerous hypoglycemia
Also prof. Leszek Cupriniak, head of the Clinic of Diabetology and Internal Medicine at the Medical University of Warsaw, noted that the moment of reaching the age of 26, when the CGM system returns, is very painful for many people with type 1 diabetes. - Many family allowances have a limit of 26 years, up to a maximum period of study. Often, these people are already working, but the cost of buying a glycemic monitoring system is high, many can not afford it. It is extremely unfortunate when a patient stops using the continuous glucose monitoring system, said Prof. Chuprinyak.
He figuratively described that these systems “open the eyes” of the patient to the glycemic profile; due to their use, severe hypoglycemia is practically eliminated, hospitalization of patients is not required. He pointed out that if a patient uses a personal insulin pump, and does not use a KGM, but a glucometer, then he does not fully use the possibilities provided by the insulin pump. “In this case, the insulin pump cannot stop the insulin infusion because it does not receive a signal that the sugar level drops to a dangerous level,” said Prof. Chuprinyak.
He also noted that in the case of diabetes, the patient is his “doctor”, because he makes specific therapeutic decisions: what to eat, what activity to take, what dose of insulin to take. In order for him to make such decisions, he needs to know his blood glucose level. - Without such knowledge, he decides blindly, which is burdened with high risk. The more often he has low blood sugar levels, the more his brain gets used to them. CGM made us realize how important it is to avoid hypoglycemia in order to prevent chronic complications of diabetes,” said Prof. Chuprinyak.
Also prof. Dorota Zozulinska-Zilkiewicz, President of the Polish Diabetes Society, stressed that a breakthrough for patients is the possibility of using real-time continuous glucose monitoring systems. - Patients who start using these systems, when they come to visit, say: “This is amazing, I can finally sleep well, work without fear, do the recommended physical activity, adjust the dose of insulin according to the needs of the body, which reduces the risk of complications” . “When people over 26 stop using continuous glucose monitoring systems, control of the disease worsens, which contributes to the occurrence of complications. There is often an aspect of disease aversion,” said Prof. Zozulinskaya-Zulkiewicz.
She noted that this is not a large population for which a reimbursement decision is important: these are patients receiving intensive insulin therapy, unaware of hypoglycemia and using personal insulin pumps. - We consider an insulin pump integrated with a continuous glucose monitoring system as a therapeutic tool. This technology is changing the lives of diabetics, and the minister’s actions are changing the face of Polish diabetes. It is worth investing in therapies that help patients achieve better and safer glycemic levels, giving them a chance for a longer life, summed up prof. Zozulinskaya-Zulkevich.
Achievement of therapy goals
Dr. Malgorzata Galonzka-Sobotka, Dean of the Institute of Health Management at Lazarski University, noted that the use of continuous glucose monitoring systems will lead to savings in the healthcare system, as the number of hospitalizations due to severe hypoglycemia will decrease. , as well as the number of visits to specialist doctors as patients are better aligned. - This is especially important in the case of a shortage of personnel in health care. The biggest problem in the coming years will be the good organization of the health care system, which should ensure not only the effectiveness of treatment, but also the persistence of the effects of therapy. We know that glycemic monitoring systems are effective, and today we must take care of maintaining the achieved therapeutic effect, and optimize costs realistically and comprehensively. The data shows how the number of complications, acute conditions and hospitalizations that could have been avoided is decreasing, says Dr. Galonzka-Sobotka.
She also pointed out that situations where people who are eligible for refunds lose them because it increases frustration should be eliminated. - Especially when it is not justified, this solution is highly effective and safe, and the patient can lead a normal life, working and paying insurance premiums. All arguments show that this is another small area of patient care that needs to be optimized. We will see the results of such decisions, said Dr. Malgorzata Galonzka-Sobotka.
Patients’ point of view
Patients with diabetes are happy with the promise of reimbursement for FGM systems, but would like to be able to choose a system for monitoring glycemia. - Diabetes is different for each patient, we would like to decide together with the doctor which system will be the best. Widespread FGM reimbursement without CGM reimbursement could result in a patient using insulin pumps being forced to switch to an FGM system for financial reasons, which is not always optimal, said Jerzy Magiera, diabetes educator, founder of mojacukrzyca. .pl, he himself has type 1 diabetes.
Therefore, patient organizations have asked the Ministry of Health to provide patients with a choice of a blood glucose monitoring system, the cost of which will be reimbursed. The second petition concerns the possibility of reimbursement for personal insulin pumps for people over 26 years of age. - Purchasing a pump is a huge concern for the patient and patients would like to better control their diabetes, improve their quality of life and avoid hypoglycemia. We call for change, we thank you for what has already been done. Any opportunity, even a partial refund, is very positively perceived by the environment, said Jerzy Magiera.
The ministry is working on changes
Maciej Milkowski, Deputy Minister of Health, who was present at the discussion, assured that the Ministry is currently analyzing all submitted applications, as well as comments submitted to the decision. - We plan to complete the analysis of the comments by September 15, and in essence completely close and sign the regulation by the end of September, with entry into force on January 1, 2023. the entry into force has been agreed, so it may be a new system that does not yet have a type 2 FGM in Poland, registered in the US as a CGM, i.e. with alarm. We have also received applications to extend reimbursement for CGM systems, in particular for patients with unawareness of hypoglycemia, and we are reviewing them,” Deputy Minister Milkowski said. He also pointed out that reimbursement for glycemic monitoring systems should mean a significant reduction in the number of glucometer strips used by diabetics.
Source: Wprost
