Risk-factor management, glucose monitoring both key to controlling diabetes

From a plan-manager perspective, eight per cent of plan members are living with diabetes, said Dr. Bruce Perkins, professor in the division of endocrinology and metabolism at the University of Toronto, during Benefits Canada’s Face to Face Drug Plan Management Forum on Dec. 9, 2020.

He said risk-factor management is necessary when it comes to smoking prevention and blood pressure and cholesterol management, which can come with pharmacotherapy and additional costs to plan sponsors. In addition, there’s a high degree of non-adherence across all types of diabetes. “There’s been a call to action for any initiative that can support people to become more engaged in their self-management of diabetes.”

Read: Managing diabetes in the new era of glucose monitoring technology  

Perkins said the target glucose level for the vast majority of people with diabetes is seven per cent or below. In the U.S., only about one in five type-one diabetes patients are meeting their blood glucose targets driven by the risk and fear of hypoglycemia, which forces people to maintain higher glucose levels that cause harm in the long term. “One way of fixing this situation is to continuously monitor glucose data, as this provides insight into blood sugar patterns.”

The primary objective of diabetes care is the day-to-day self-management and maintaining a blood sugar level of about four to 10 throughout the day, at least 70 per cent of the time, he said, while the second is to determine glycaemic patterns to plan for the future. One possible method is flash glucose monitoring, which allows users to track and share their recent blood sugar levels with their mobile device, he said. “Every time they swipe, it logs this information; it’s there for review by a patient’s care team or themselves. It doesn’t require finger-stick calibrations and compared to these other systems that have particular purposes, this is much less expensive. I can make this beautiful determination of how they’re doing, but also what to do with their medications and what coaching I would give to that patient. I can do that with a hundred per cent confidence.”

Read: The impact of hypoglycemia on workplace absenteeism

A lot of the evidence around flash glucose monitoring is around preventing hypoglycemia, which can disrupt an individual’s workday and even be life-threatening, Perkins said. He cited a pre-post observational study by the U.K. National Health Service of flash glucose monitoring implemented at a population level, which resulted in a large reduction in hospital admissions for hyper and hypoglycemia. “This translated to a number of pertinent outcomes, such as reductions in absenteeism from work, as well as an improvement in glycemic exposure by helping patients to be more engaged.”

Read more stories from the 2020 Face to Face Drug Plan Management Forum.