Access to new technologies and alleviating variation to access
A holistic approach to diabetes
Roche Diabetes Care envisions a holistic approach to addressing the diabetes challenge. Driven by technology and integrated solutions, insulin pumps have evolved rapidly since their introduction nearly 40 years ago, and CGM over the last 15 years. However there is variation in access and uptake in the UK & Republic of Ireland1.
- Perera et al (2018) Variations in access to and reimbursement for continuous glucose monitoring systems for people living with Type 1 diabetes across England. Diabetic Medicine [Epub ahead of print] doi: 10.1111/dme.13766
Insulin pump therapy
Insulin therapy, by means of continuous subcutaneous insulin infusion (CSII), is an efficient and flexible method of insulin delivery that can be associated with improved glycaemic management and clinical outcomes1,2.
Insulin pumps are now smaller, more precise and more reliable than their predecessors. There is growing use of insulin pumps in individuals with T1D of all age groups, with many pumps now having dedicated meters for self-monitoring of blood glucose (SMBG). These can automatically send blood glucose readings to the pump and are equipped with algorithms for suggesting bolus doses based on user-estimated grams of carbohydrate and blood glucose level.
Whilst insulin pump usage has grown from 7% ( in 2013) to 15.6% in England and 6.7% in Wales there continues to be disparity from 100% using insulin pumps in one centre to 0.6% in another3.
- Pickup JC, Keen H, Parsons JA, Alberti KG (1978). Continuous subcutaneous insulin infusion: an approach to achieving normoglycaemia. BMJ 1:204–207
- Pickup J (2013) Insulin pumps. Diabetes Technol Ther. 15(Suppl 1): S24–S28
- National Diabetes Audit 2016-2017
Continuous glucose monitoring (CGM)
Since the introduction of continuous glucose monitoring (CGM) systems more than 15 years ago, CGM has been shown to improve quality of life and outcomes for people with diabetes. Studies have demonstrated that CGM can reduce HbA1c, independent of insulin delivery modality, while also decreasing time spent in hypoglycaemia1 as well as reducing glycaemic variability2.
CGM can improve quality of life and reduce diabetes-related distress3 including fear of hypoglycaemia4,5. Recent trials have identified that CGM systems used in combination with insulin pumps incorporating low glucose suspend functions, have the potential for even greater benefits including reduced work absenteeism and admissions for acute diabetes complications5,6. Despite this, CGM has yet to be fully implemented as part of the standard of care for certain people living with type 1 diabetes (T1D) and consistent reimbursement has been a challenge for healthcare systems7.
- Liebl A, Henrichs HR, Heinemann L, Freckmann G, Biermann E, Thomas A. Continuous glucose monitoring: evidence and consensus statement for clinical use. J Diabetes Sci Technol. 2013;7(2):500-19.
- Block CD, Manuel-y-Keenoy B, Gaal LV. A Review of Current Evidence with Continuous Glucose Monitoring in Patients with Diabetes. Journal of diabetes science and technology (Online). 2008;2(4):718-27.
- Polonsky WH, Hessler D, Ruedy KJ, Beck RW. The Impact of Continuous Glucose Monitoring on Markers of Quality of Life in Adults With Type 1 Diabetes: Further Findings From the DIAMOND Randomized Clinical Trial. Diabetes Care. 2017.
- Halford J, Harris C. Determining clinical and psychological benefits and barriers with continuous glucose monitoring therapy. Diabetes Technol Ther. 2010;12(3):201-5.
- Charleer S, Mathieu C, Nobels F, et al. Effect of Continuous Glucose Monitoring on Glycemic Control, Acute Admissions and Quality of Life: A Real-World Study. JCEM. 2018. DOI: 10.1210/jc.2017-02498
- Klonoff DC, Ahn D, Drincic A. Continuous glucose monitoring: A review of the technology and clinical use. Diabetes Res Clin Pract. 2017;133:178-92.
- Heinemann L, DeVries JH. Reimbursement for Continuous Glucose Monitoring. Diabetes Technology & Therapeutics. 2016;18(Suppl 2):S2-48-S2-52.