metricas
covid
Buscar en
Endocrinología, Diabetes y Nutrición (English ed.)
Toda la web
Inicio Endocrinología, Diabetes y Nutrición (English ed.) Strategy and results of the massive implementation of reimbursed continuous gluc...
Información de la revista
Vol. 70. Núm. S3.
Páginas 73-75 (septiembre 2023)
Vol. 70. Núm. S3.
Páginas 73-75 (septiembre 2023)
Scientific letter
Acceso a texto completo
Strategy and results of the massive implementation of reimbursed continuous glucose monitoring in people with type 1 diabetes
Implantación masiva de la monitorización continua de glucosa en personas con diabetes tipo 1 en una Unidad de Diabetes de referencia bajo financiación pública: estrategia y resultados
Visitas
194
Irene Pueyoa, Clara Viñalsa, Alex Mesaa,
Autor para correspondencia
almesa@clinic.cat

Corresponding author.
, Marga Giméneza,b,c, Ignacio Congeta,b,c
a Servicio de Endocrinología y Nutrición, Hospital Clínic de Barcelona, Barcelona, Spain
b Institut d’investigacions biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
c Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (1)
Suplemento especial
Este artículo forma parte de:
Vol. 70. Núm S3
Más datos
Texto completo

The use of continuous glucose monitoring (CGM) in type 1 diabetes (T1D) has been shown to reduce some acute complications, improve glycaemic control and improve patient satisfaction regarding its use.1–3 Recently, those countries that have introduced widespread public funding for these devices, such as the UK,4 Belgium,5 Sweden6 and France,7 have published their results available to date, confirming positive real-life outcomes in terms of HbA1c reduction, hospital admissions for acute complications and improved patient satisfaction compared with standard capillary blood glucose testing.

In Spain, public funding for CGM has been approached differently from one autonomous region to the next. In Catalonia, this funding was established in different phases, the latest of which included general funding for all patients with T1D.8 The large number of patients included in this last implementation phase led us to evaluate the feasibility and effectiveness of a decision algorithm (Fig. 1) aimed at the widespread implementation of CGM in people with T1D seen at our Diabetes Unit in the shortest possible time. In our case, the use of the FreeStyle Libre flash CGM device was prioritised.9 An administrative professional, supported by healthcare personnel, contacted the candidates and included them in the programme according to their technological skills. New users received device information, a contact phone number and a link to a training webinar. Those less familiar with technology and with the least technological skills received face-to-face training in small groups.

Figure 1.

Decision algorithm used for the widespread implementation of continuous glucose monitoring in people with T1D.

CGM: continuous glucose monitoring; MRN: medical record number; T1D: type 1 diabetes.

(0.21MB).

Over a period of three and a half months, from 1 March to 15 June 2021, 1,519 candidates were contacted by telephone (52% female, mean age 43.82±15.29 years, mean HbA1c 7.71%±1.19, 19% of whom were subcutaneous insulin pump users). A total of 1,045 patients (69%) started using the funded CGM, of whom 320 (21%) had previously self-financed the use of CGM; 331 people (22%) refused to use the device and 143 people (9%) could not be contacted. In webinars led by a diabetes nurse educator, 292 patients (29%) were included, while only 39 (3%) required face-to-face training. The majority of patients who refused to start CGM reported a lack of interest in using the device (45% of cases), while 17% preferred to make a decision after consulting their regular endocrinologist. No significant acute complications or relevant clinical issues were recorded. A modest increase in the number of device inquiries was observed (a total of 190 calls and 11 unscheduled face-to-face visits).

A Spanish study was recently published in this journal that showed that the incorporation of an educational programme in group and telematic format on the use of flash CGM devices, as part of the implementation strategies of these systems, is an effective option with associated benefits in terms of quality of life and fear of hypoglycaemia, which can be implemented in routine clinical practice in adult patients with T1D.10 Our study adds new information in this regard and demonstrates that the widespread implementation of funded CGM in the population with T1D in a short period of time is feasible, safe and effective through the use of coordinated strategies between healthcare and non-healthcare professionals, including face-to-face and virtual visits and online educational support.

References
[1]
J.C. Pickup, S.C. Freeman, A.J. Sutton.
Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data.
BMJ, 343 (2011), pp. d380
[2]
R. Jiménez-Sahagún, E. Gómez Hoyos, G. Díaz Soto, M.O. Nieto de la Marca, M. Sánchez Ibáñez, S. del Amo Simón, et al.
Impacto del inicio de la monitorización flash de glucosa en la calidad de vida y en los parámetros de control glucémico de pacientes adultos con diabetes tipo 1.
Endocrinol Diabetes Nutr, 69 (2021), pp. 345-353
[3]
A. Muñoz, R. Martín, P. Gil, A. Mariscal, A. Puchades, et al.
La Monitorización Flash de Glucosa, una buena herramienta para el empoderamiento de la persona con diabetes.
Enferm Integral, 117 (2017), pp. 53-58
[4]
H. Deshmukh, E.G. Wilmot, R. Gregory, D. Barnes, P. Narendran, S. Saunders, et al.
Effect of flash glucose monitoring on glycemic control, hypoglycemia, diabetes-related distress, and resource utilization in the association of british clinical diabetologists (ABCD) nationwide audit.
Diabetes Care, 43 (2020), pp. 2153-2160
[5]
S. Charleer, C. De Block, L. Van Huffel, B. Broos, S. Fieuws, F. Nobels, et al.
Quality of life and glucose control after 1 year of nationwide reimbursement of intermittently scanned continuous glucose monitoring in adults living with type 1 diabetes (FUTURE): a prospective observational real-world cohort study.
Diabetes Care, 43 (2020), pp. 389-397
[6]
D. Nathanson, A.M. Svensson, M. Miftaraj, S. Franzén, J. Bolinder, K. Eeg-Olofsson.
Effect of flash glucose monitoring in adults with type 1 diabetes: a nationwide, longitudinal observational study of 14,372 flash users compared with 7691 glucose sensor naive controls.
Diabetologia, 64 (2021), pp. 1595-1603
[7]
R. Roussel, J.-P. Riveline, E. Vicaut, G. de Pouvourville, B. Detournay, C. Emery, et al.
Important drop rate of acute diabetes complications in people with type 1 or type 2 diabetes after initiation of flash glucose monitoring in France: the RELIEF study.
Diabetes Care, 44 (2021), pp. 1368-1376
[9]
M.M. Visser, S. Charleer, S. Fieuws, C. De Block, R. Hilbrands, L. Van Huffel, et al.
Comparing real-time and intermittently scanned continuous glucose monitoring in adults with type 1 diabetes (ALERTT1): a 6-month, prospective, multicentre, randomised controlled trial.
Lancet, 397 (2021), pp. 2275-2283
[10]
P. Rodríguez de Vera-Gómez, C. Mateo-Rodríguez, C. Vivas-López, I. Serrano-Olmedo, M. Méndez-Muros, C. Morales-Portillo, et al.
Efectividad de un programa de implantación de sistemas de monitorización flash de glucosa a través de una intervención educativa grupal y telemática en adultos con diabetes tipo 1.
Endocrinol Diabetes Nutr, (2021),
Copyright © 2022. SEEN and SED
Descargar PDF
Opciones de artículo
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos