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Using new technology to improve glucose control: The need to reduce health inequality
We are just coming up to 100 years since insulin was first used to treat diabetes mellitus: clearly a dramatic turning point in the management of this disease. A perhaps less dramatic but, it could be argued, equally important development was the ability to monitor capillary glucose and thus adjust the insulin dose. Devices to measure capillary glucose first became available in the 1970s. Although not many of today’s clinicians will remember this, a significant number of our patients with type 1 diabetes will.
Capillary blood glucose testing has been the standard tool for monitoring and adjusting diabetes treatment for 50 years, but it would seem we are now at another turning point. Continuous glucose monitoring has now been available for over 20 years but it is only in very recent times that we have seen its widespread use. Having now achieved a certain momentum, we are seeing a very rapid rise in the uptake of this technology. In the UK, this is despite commissioning restrictions in place to try and limit the use.
We already know that the more information a person has about their glucose levels, the better control of glucose they achieve. It would seem intuitively obvious that having a continuous record of glucose levels should allow for more accurate adjustment of diabetes treatment than just having two or three moments per day when we know what the level is. The paper by Anita Jeyam and colleagues addresses the question of whether this benefit is restricted to certain groups of patients or whether we are likely to see benefit across the board. The answer from their real-world study strongly suggests that the benefit is universal.
There is a danger in the diabetes clinic that people who are managing their condition well are offered the latest technology to help them improve further, while those who are struggling, for whatever reason, can be left behind. It is possible that the current commissioning arrangement for both flash and continuous glucose monitoring is contributing to this health inequality. In the interest of achieving value for money, we may be penalising the group of patients who potentially have the most to gain. The data from this Scottish paper would support that view. It seems probable that the increasing use of sensor technology will reduce the disease burden of diabetes.
Regardless of the health-economic arguments, these devices are achieving a momentum of their own. The right thing to do is to widen their availability. Now would seem the time to do this.
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