On the occasion of the 25th Congress of the Spanish Diabetes Society, held in Granada, Ascensia Diabetes Care, in collaboration with Dr. Macarena Alpañés, Dr. Miguel Borrachero, Dr. Maite Herrera and the consulting firm P360º, have announced the report “Capillary blood glucose in times of continuous glucose monitoring”, a current x-ray of the real use of both technologies in the management of type 1 diabetes (DM1) in Spain.
The research for this report was carried out through a online survey and patient event Diabetes Experience Dayheld in Albacete in 2023. The data was obtained between December 2022 and March 2023. During that period, almost 400 people with type 1 diabetes (DM1) without an insulin pump participated anonymously and disinterestedly.
Almost 70% of those surveyed were between 18 and 65 years old. The percentage of men and women was similar. Castilla y León, Madrid and Andalusia were the regions with the highest participation in the survey.
Current use of continuous glucose monitoring (CGM) and flash glucose monitoring (FGM)
The General Directorate of the Common Portfolio of Services of the National Health and Pharmacy System in Spain agreed on July 22, 2021 that the continuous glucose monitoring in real time (CGM), could be prescribed by endocrinologists as an alternative to blood glucose test strips in adults (18 years or older) with DM1 and risk of severe hypoglycemia, who were prescribed multiple daily doses of insulin or with a pump. insulin and required at least six fingersticks for self-monitoring of blood glucose (WAGGGS).
The use of these systems has represented progress, but it has also raised questions among the group of patients and healthcare professionals. He Dr. José Miguel Borrachero, family doctor at the Peral Health Center in Cartagena, highlights that “the majority of people with diabetes who use continuous blood glucose monitoring are satisfied and would not stop using it”; However, he qualifies, “Your expectations at first seem very high and Over time, trust in these systems decreases.”.
In practice, these available technologies have several deficiencies. According to this report, people with diabetes report some aspects that limit their clinical benefits, such as accuracy and discrepancy of values. In fact, 60% of those surveyed observed differences between the values provided by the sensor they use and capillary blood glucose.
The accuracy of CGM/MFG systems continues to be the great request of people with diabetes, as it conditions their decision-making in self-management of treatment. Given that the main reason for performing capillary blood glucose is the suspicion of inaccuracy of the value given by the sensor, the Dr. Maite Herrera, endocrinology of the Nuestra Señora de la Candelaria University Hospital in Tenerife, assures that “The accuracy of the glucometer is essential to perform capillary blood glucose.”
Professionals indicate that measurement systems (CGM/MFG) must improve their level of certainty and provide peace of mind and confidence to users, especially in the case of hypoglycemia, which continues to be an unresolved need for patients. In fact, Almost 70% of those surveyed report having experienced nocturnal hypoglycemia more than 3 times during the last year.
This is especially important considering the high economic impact that diabetes has for the Spanish health system. According to the SECCAID study1, the direct cost of diabetes for the system is 8.2% of total expenditure, which means about 5.8 billion euros (between hospital and pharmacological costs). A inadequate glycemic control leads to an increase in direct expenditure, but also that derived from the complications of the disease.
Users also indicate in the survey other types of problems such as self-insertion of the sensor. 49% indicate that the sensors come off easily. In addition, 37% experience frequent disconnections from the App with the sensor or sensor errors that lead to periods of time without blood glucose measurements.
Coexistence between CGM/MFG and capillary glycemia
The technological revolution brought about by sensors coexists in time and form with the use of glucometers and test strips. The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) published, in 2022, a series of recommendations2 for the coexistence of capillary measurement and continuous glucose monitoring in the following cases:
- When CGM/MFG is suspected to be inaccurate.
- During sensor warm-up.
- For calibration (some sensors).
- Before alert messages.
- In any clinical situation where glucose levels change rapidly (>2 mg/dL/min), which could cause a discrepancy between the CGM and blood glucose value.
- To check fasting control, before meals and snacks, at bedtime, before exercise, when low blood glucose is suspected, after treating low blood glucose to normal levels. normal blood glucose levels.
- Before and during performing critical tasks such as driving.
According to the report prepared, 96% of people with type 1 diabetes in Spain consider it essential to have a glucometer today to measure their capillary blood glucose.. For the Dr. Macarena Alpañés, endocrinologist at the Ramón y Cajal Hospital in Madrid, “checking the sensor levels is probably due to distrust in the measurements obtained with CGM”; And, as he admits, “Although the difference between interstitial and capillary glucose is always explained, this is a concept that can be complicated for some people.” A situation that for Dr. Alpañés “reveals the need to maintain test strips in patients with CGM because, although their use is reduced, it is not completely eliminated and they must be available when they are necessary.”.
In this sense, Dr. Maite Herrera ensures that “despite the level of satisfaction in the use of these CGM systems, The technology that patients carry today is not ready to completely dispense with test strips.”.
Dr. Borrachero concludes that, “It will take a long time before we can say that the use of capillary measurement is not necessary in people with diabetes who use insulin. Today, no matter how good the interpretation algorithms for measuring interstitial glycemia are, which are increasingly so, it will be very difficult for them to solve the difficulties of measuring interstitial glycemia.”
The Spanish users consulted refer to the use of capillary blood glucose in four different scenarios: – 23% of respondents use the glucometer to check their sensor values; – 21% when they have hypoglycemia; – 20% having symptoms that do not match the sensor value; and 4) 19% when the sensor fails and there is time without measurement.
References:
1. Crespo C, Brosa M, Soria-Juan A, Lopez-Alba A, López-Martínez N, Soria B. Direct costs of diabetes mellitus and its complications in Spain (SECCAID Study: Spain estimated cost Ciber-demCabimer in Diabetes ). Av Diabetol. 2013;29(6):182-9.
2. American Diabetes Association. Section 7. Diabetes Technology: Standards of Medical Care in Diabetes. Diabetes Care – 2022. 2022;45(Suppl_1): S97–S112. 2. Holt RIG et al. Diabetes Care. 2021;44(11):2589-2625.
Fountain: Ascensia