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“Space Technologies” for diabetes monitoring. Wprost debate with Deputy Minister Miłkowski – Zdrowie Wprost

"Space Technologies" for diabetes monitoring.  Wprost debate with Deputy Minister Miłkowski - Zdrowie Wprost

The situation of diabetics in Poland is improving, which can be seen in the reimbursement lists, which include new drugs for this group of patients (since September, access to floaters and analogues of GLP-1 has been obtained by a much larger group of patients). However, not only medications affect the effectiveness of diabetes management: numerous studies and clinical practices show that effective means of controlling blood sugar are just as important as medications. In this regard, there has been a revolution in recent years, and traditional blood glucose meters are slowly becoming obsolete.

Female genital mutilation and CGM, that is, the necessary customization of treatment

a. Małgorzata Myśliwiec, Head of the Department of Pediatrics, Diabetes and Endocrinology at the Medical University of Gdask, who has been caring for children and adolescents with type 1 diabetes for years, there is no doubt that glycemic control systems are a breakthrough in civilization. There are two basic types. The first is the blood glucose monitoring system (FGM): the patient must bring the receiver closer to the sensor to obtain the result. – He sees not only the measurement of points, but also the trends of changes in blood glucose. The patient knows exactly how his sugar level rises or falls, for example, after a meal or physical activity, can make appropriate treatment decisions – said the professor. fighter.

She noted that thanks to the use of this regimen, patients treated with intensive insulin therapy have significant benefits, but it is not optimal for patients with hypoglycemia. They do not have any warning signs of hypoglycemia and therefore cannot measure their glucose levels at this time. They are also at risk of developing hypoglycemia at night. Another problem is that the patient who has survived an episode of hypoglycemia is afraid that it will not happen again, so he tries to maintain higher levels of glucose in the blood, which leads to worse control of diabetes – the professor emphasized. fighter. Therefore, continuous, real-time monitoring systems are more effective for patients with type 1 diabetes and hypoglycemia unawareness. They constantly monitor your blood glucose levels, alert you to impending hypoglycemia, and stop insulin delivery if necessary.

Both types of regimens are compensated for children and adolescents, but compensation for FGM ends after the age of 18 years, and for CGM – after the age of 26 years. The draft regulation, published in July, provides for an extension of reimbursement to adult female genital mutilation regulations as well. However, experts and patients point out that the group of patients with type 1 diabetes and unconscious hypoglycemia, especially those using personal insulin pumps, should still be able to use continuous glucose monitoring. Our experience and our large international studies have shown that CGM, in combination with a personal insulin pump, prevents 100% of severe hypoglycemia. Compensation of these regimens for people over 26 years of age would significantly improve diabetes control, and in patients with hypoglycemia, it would prevent episodes of severe hypoglycemia – emphasized the professor. fighter.

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Serious hypoglycemia

also mr. Leszek Kzuprinjak, Head of the Clinic for Diabetes and Internal Medicine at Warsaw Medical University, noted that the moment of turning 26, when the CGM recovery period ends, is very painful for many people with type 1 diabetes. A limit of 26 years has been set for many family benefits, up to the maximum length of education. Often these people actually work, but the costs of purchasing a blood sugar monitoring system are significant, and not many people can afford it. Professor A.D. Czubrynak.

It has been figuratively described that these systems “open the eyes” of the patient to their glycemic profile; Thanks to their use, severe hypoglycemia is practically eliminated, and patients do not need to be hospitalized. He pointed out that if the patient uses a personal insulin pump, and does not use a continuous glucose monitor, but a glucose meter, then he does not fully use the capabilities offered by the insulin pump. – The insulin pump can no longer stop the insulin pump, because it does not receive a signal that the sugar level has dropped to dangerous levels – said the professor. Czubrynak.

He also noted that in the case of diabetes, the patient is his “doctor” because he makes specific treatment decisions: which meal to eat, what activity to take, and what dose of insulin to take. In order to make such decisions, he needs to know the level of sugar in the blood. Without this knowledge he decides blindly, burdened with high risks. The more often he has low blood sugar, the more his brain gets used to it. Professor Dr. said. Czubrynak.

also mr. Dorota Zozulińska-Ziółkiewicz, President of the Polish Diabetes Association, emphasized that the breakthrough for patients was the possibility of using real-time continuous glucose monitoring systems. – Patients who have started using these regimens say when they come to visit: “It is amazing, I can finally sleep well, work without fear, do the recommended physical activity, and adjust the insulin dose according to the needs of the body, which reduces the risk of complications.” Persons over 26 years of age discontinue use of continuous glucose monitoring regimens, as disease control worsens, contributing to the development of complications. Often there is also an aspect of not accepting the disease – said the professor. Zozulińska-Ziółkiewicz.

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She noted that this is not a large population for which the reimbursement decision is important: these patients are on intensive insulin therapy, are unaware of hypoglycemia, and use personal insulin pumps. We consider the integrated insulin pump with continuous glucose monitoring system to be a therapeutic tool. This technology is changing the lives of diabetics, and the minister’s actions are changing the face of diabetes in Poland. It’s worth investing in treatments that help patients achieve better and safer blood sugar, giving them a chance for a longer life — in short, the professor. Zozulińska-Ziółkiewicz.

Achieving treatment goals

Dr. Magorzata Gawzka Sobotka, Dean of the Institute of Health Care Management at Lazarski University, noted that the use of continuous glycemic monitoring systems would translate into savings in the health care system, as the number of hospitalizations for severe hypoglycemia would decrease. In addition to the number of visits to specialist doctors where patients will be better matched. – It is especially important in the case of a shortage of personnel in health care. The biggest challenge in the coming years will be the good organization of the health care system, which not only ensures the effectiveness of the treatment, but also the durability of the effects of the treatment. We know that glycemic control systems are effective, and today we must take care to maintain the achieved therapeutic effect, in order to realistically and comprehensively optimize costs. Dr. Jazka Sobotka said the evidence shows that the number of complications, acute cases and avoidable hospitalizations have been reduced.

She also pointed out that cases in which people entitled to repayment lose what increases their frustration must be eliminated. – Especially when it is not justified, the given solution is very effective and safe, and the patient can lead a normal life by working and paying insurance premiums. All the arguments show that this other small area of ​​patient care deserves improvement. We will see the results of such decisions – said Dr. Małgorzata Gałązka-Sobotka.

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patient’s perspective

Diabetics are happy with the promise of compensation for FGM systems, but would like to opt for a blood sugar monitoring system. – Diabetes is different in each patient, we would like to be able to determine the best regimen with the doctor. Extensive reimbursement of an FGM system, without CGM compensation, may force a patient using insulin pumps to switch to an FGM system for financial reasons, and this is not always optimal — said Jerzy Magira, diabetes educator, founder of Mojacukrzyca. pl portal, who himself has type 1 diabetes.

Therefore, patient organizations petitioned the Department of Health to give patients the option to choose which blood glucose monitoring system would be compensated. The second petition concerns the possibility of reimbursement for personal insulin pumps for people over the age of 26. -Purchasing the pump is a big challenge for the patient, patients would like to have better diabetes control, better quality of life, and avoid hypoglycemia. We call for changes and thank you for what has been achieved so far. All possibilities, even a partial recovery, were well received by the environment, Jerzy Magera said.

The Ministry is working on changes

Maciej Miłkowski, Deputy Minister of Health, who was present at the discussion, confirmed that the ministry is currently analyzing all applications submitted, as well as comments made on the regulation. – We plan to complete the comment analysis by September 15, basically shut down the entire system and sign the regulation by the end of September, with it coming into effect from January 1, 2023. In the case of FGM, a date has been agreed to enter into force so that it can be a new system, and with That There is no FGM type 2 in Poland, registered in the United States as CGM, ie with alarms. We have also received requests to extend reimbursement for continuous diabetes monitoring systems, especially for patients who are unconscious of hypoglycemia, and we are analyzing them – said Deputy Minister Mikowski. He also noted that reimbursement for blood sugar monitoring systems should mean a significant reduction in the amount of blood glucose strips used by diabetics.

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