Type 1 diabetes

Encouraging early results with flash glucose monitoring

Flash glucose monitoring is helping patients with insulin-dependent diabetes achieve better glycaemic control, endocrinologists in Victoria say.

Reporting their early experiences with the Freestyle Libre device in clinical practice, clinicians at Austin Health report that 22 patients achieved significant reductions in mean HbA1c levels, from 8.7% to 7.7% in two weeks of use.

In a pre/post use audit of patients with type 1 and type 2 diabetes who used the device between January and March 2017, the most dramatic reductions were seen in four patients with type 2 diabetes whose mean pre-use HbA1c levels ranged from 9.5% to 14.5%, which dropped to between 7.8% to 9%.

The improved outcomes, combined with the convenience over conventional finger-prick testing for blood glucose testing, suggest that flash glucose monitoring “appears to be a promising diabetes management tool in the clinical setting” according to Associate Professor Neale Cohen, Director of Clinical Diabetes at the Baker Heart and Diabetes Institute in Melbourne.

“Advantages of flash glucose monitoring are no need for finger pricking, convenience, speed and providing real time feedback about glucose trends in response to meals, exercise and insulin,” he writes in a research letter in the Australian Journal of Rural Health co-authored by Associate Professor Elif Ekinci, Professor Jeffrey Zajac and Dr Jeremy Weiss from Austin Health.

The article notes that unlike other continuous blood glucose monitoring devices, the flash monitoring device does not require calibration and provides real-time feedback from a subcutaneous sensor that measures glucose levels in interstitial fluid every 15 minutes. The display also stores glucose levels for 90 days and can shows on glucose trends in response to meals, exercise and insulin

The wearable device is most suitable for patients with type 1 diabetes and complex type 2 diabetes who are injecting insulin more than once a day, Professor Cohen told the limbic.

But cost is proving a major barrier to patients access. The device costs around $2500 per year, largely because the sensors cost $92.50 each and must be replaced every two weeks.

“Our patients would dearly love to have this technology [but] most people can’t unfortunately afford this,” Professor Cohen said.

Some patients reduce the cost by only using the technology for two weeks each month. Intermittent use is better than no use, because it still provides information that can help patients adjust diet and insulin when needed, Professor Cohen said.

“But ideally we’d like to see some subsidy from the government for these sensors, just to help them out. Some people really need this technology.”

In 2017 manufacturer, Abbott applied to have its device subsidised through the National Diabetes Service Scheme (NDSS) and is awaiting an outcome.

Diabetes Australia supports the application, said CEO Professor Greg Johnson.

“Blood glucose testing is one of the most intrusive and difficult parts of living with diabetes and that’s why we support technology that makes this part of life with diabetes easier.

“Flash glucose monitoring is an easy and convenient form of glucose monitoring and has recently been subsidised by the UK Government for people with type 1 diabetes”.

Professor Cohen said he sits on an advisory board for Abbott.

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