A International panel of endocrinologists, diabetologists and family physicians has recommended the use of continuous glucose monitoring (CGM) technologysuch as the FreeStyle Libre 2 and FreeStyle Libre 3 systems, in all people with type 2 diabetes mellitus (T2DM) immediately after diagnosis. The consensus report, published in the journal Nature Reviews Endocrinology 2, thus maintains that CGM systems should be used from the moment a diagnosis of type 2 diabetes is received and throughout the rest of life.
And, as the document reflects, it is proven that intensive glucose control after the initial diagnosis of DM2 significantly reduces the risk of developing microvascular complications associated with diabetes, such as retinopathy, chronic kidney disease or neuropathy2. In addition, it also consistently reduces the risk of myocardial infarction and death from other causes.
On the contrary, experts estimate that one year delay in treatment intensification in people with a recent diagnosis of T2DM yy HbA1c >7.5% (58 mmol/mol) is associated with an increased risk of myocardial infarction of 67%, with an increase of 51% of stroke risk and 64% of heart failurecompared to people who receive treatment intensification early3. Therefore, early glycemic control is essential to prevent complications derived from type 2 diabetes, which can change the lives of these people in the long term and which have a strong impact on the costs associated with hospital admissions, managing to reduce them.
In the words of Francesc Xavier Cos ClaramuntInnovation in Health Manager of the Institut Català de la Salut, associate professor at the Autonomous University of Barcelona and Chair of Primary Care Diabetes Europe and one of the experts who participated in the study, “The diagnosis of type 2 diabetes is usually accompanied by the modification of deeply ingrained habits in the person. CGM systems allow for much more precise knowledge, for both the doctor and the patient, of the routines that should be modified. It helps the person with diabetes to be more aware of their lifestyle and allows them to commit to the challenge of changing their previous habits.” .
Key features of CGM technology
Although the medical community already considers the CGM as a standard treatment for people following intensive insulin therapy, the European group of experts adds that this technology is also an essential tool after the immediate diagnosis of type 2 diabetes. In this sensehelps the doctor establish his patient’s glucose profile, decide the initial treatment plan and evaluate him after 14 days. Additionally, it also provides information on the response of glucose levels to prescribed diet and exercise, which can lead to achieving and maintaining a healthy body weight that makes the condition more manageable.4keeping in mind that the optimal state of health for people with T2DM depends in part on their degree of success in adhering to lifestyle recommendations 5.
Real-time information on glucose levels allows people with type 2 diabetes to have better adherence to treatment since their diagnosis and to follow a healthy lifestyle, which promotes optimal long-term diabetes management,” he says. José Luis Porteromedical director of Abbott Diabetes in Spain.
Thus, a key feature of FreeStyle Libre is that users can get biofeedback immediately, through visible minute-by-minute glucose readings and trend diagrams that show current glucose levels and how quickly they are changing. This type of information is very useful, since allows people with T2DM to adapt their diet and physical activity to improve their daily glucose profiles, so it is not possible with intermittent capillary glucose analysis. Thus, decision-making assisted by CGM systems has already demonstrated its effectiveness in people with DM2 treated with basal insulin.6 and these new data reveal this same potential in people with recently diagnosed DM27.8.
access to CGM in Spain
Spain, the General Directorate of the Common Portfolio of Services of the National Health and Pharmacy System established the roadmap to follow in the implementation of CGM systems in 2022, after prior financing of this technology for people with type 1 diabetes9. Thus, although the speed of access has been uneven at the territorial level, CGM systems are currently available for people with T2DM at the national level. Although it is true that its total availability for those living with this condition will arrive throughout 2024.10.
This full access will mean a economic savings for the National Health System, as various studies have shown. And, according to research carried out by researchers at the Ramón y Cajal University Hospital, in the Community of Madrid alone, the average cost of complications derived from type 2 diabetes per patient is 4,121.54 euros, 66% of which is due to macrovascular complicationseleven.
The setting of deadlines by the Ministry of Health for access to CGM among people with type 2 diabetes has responded to medical criteria. However, the progressive prescription of this technology for those living with this condition is in line with the global chronicity strategy of the SNS, which aims to continue promoting planned and anticipated decision-making, as well as the development of treatment plans. individualized action, which contributes to the sustainability of the health system12.
References:
1.- Ajjan, RA et al. Continuous glucose monitoring in persons with type 2 diabetes mellitus who are not on intensive insulin therapy. Nature Reviews Endocrinology (2024) doi:10.1465/67poy.
2.- Lind, M., Imberg, H., Coleman, RL, Nerman, O. & Holman, RR Historical HbA1c Values May Explain the Type 2 Diabetes Legacy Effect: UKPDS 88. Diabetes Care 44, 2231–2237 (2021) .
3.- Paul, SK, Klein, K., Thorsted, BL, Wolden, ML & Khunti, K. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol 14, 100 (2015).
4.- https://www.cdc.gov/diabetes/managing/healthy-weight.html
5.- Denicolò S, Perco P, Thöni S, Mayer G. Non-adherence to antidiabetic and cardiovascular drugs in type 2 diabetes mellitus and its association with renal and cardiovascular outcomes: A narrative review. J Diabetes Complicat 2021;35:107931. https://doi.org/10.1016/j.jdiacomp.2021.107931
6.- Martens, T. et al. Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin. Jama 325, 2262–2272 (2021).
7.- O’Connor, MJ et al. A Pilot Trial of Continuous Glucose Monitoring Upon Emergency Department Discharge Among People With Diabetes Mellitus. Endocr. Pr. 30, 122–127 (2024).
8.- Oser, TK et al. An Innovative, Paradigm-Shifting Lifestyle Intervention to Reduce Glucose Excursions With the Use of Continuous Glucose Monitoring to Educate, Motivate, and Activate Adults With Newly Diagnosed Type 2 Diabetes: Pilot Feasibility Study. JMIR Diabetes 7, e34465 (2022).
9.- Resolution of April 7, 2022, of the General Directorate of the Common Portfolio of Services of the National Health and Pharmacy System [Ministerio de Sanidad]. By which the agreement of the Benefits, Insurance and Financing Commission of March 2, 2022 on the glucose monitoring system for patients with type 2 diabetes mellitus in the common portfolio of services of the National Health System is made public. Available at: https://www.sanidad.gob.es/professionals/prestacionesSanit… DM2_DEF.pdf
10.- Resolution of October 28, 2022, of the General Directorate of the Common Portfolio of Services of the National Health and Pharmacy System [Ministerio de Sanidad]. by which the agreement of the Benefits, Insurance and Financing Commission of July 21, 2022 is made public in relation to the prioritization of patients with type 2 diabetes mellitus who undergo intensive insulin therapy and require at least six digital punctures per day. day for self-monitoring of blood glucose, to which glucose monitoring systems are provided. Available in:
https://www.sanidad.gob.es/profesionales/prestacionesSanitarias…… Colectivos_DM2.pdf
11.- Francisco Arrieta, Carlos Rubio-Terrés, Darío Rubio et al. Estimation of the economic and health impact of complications of type 2 diabetes mellitus in the Community of Madrid. Endocrinology and Nutrition Volume 61, Issue 4, April 2014, Pages 193-201.
12.- Ministry of Health (2021). Evaluation report and priority lines of action of the Strategy for Addressing Chronicity of the SNS. Available in:
https://www.sanidad.gob.es/areas/calidadAsistencial/estrat… onicidad_en_el_SNS_2021.pdf
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