Innovative technology to monitor glucose levels for patients with diabetes offers improved health outcomes, reduced absenteeism and improved productivity, said Rick Siemens, certified diabetes educator pharmacist, during a webinar in June hosted by Benefits Canada and sponsored by Dexcom.
The roles of pharmacists in Canada are evolving. Siemens said he spends most of his time supporting and helping patients with diabetes manage their condition. Multiple studies have demonstrated the effectiveness and positive health outcomes of pharmacists providing patients with diabetes care.
Glucose monitoring has also evolved and improved the lives of patients. Instead of finger pricks, continuous glucose monitoring gives a real-time view of a patient’s glucose levels and provides important data to medical professionals, patients and their caregivers.
Hypoglycemia (low blood sugar) episodes can lead to confusion and disorientation or be life-threatening due to potential loss of consciousness, seizure or coma. In addition to the physical and mental toll, the patient — and potentially their caregiver — might have to leave school or work and possibly miss the next day to recover. “One of the biggest reasons that some patients do not have control of their blood sugars is their fear of hypoglycemia — they may keep their blood sugars high to avoid potential lows,” said Samir Mistry, vice-president of pharmacy at PreferredOne.
One of the key diabetes management tools is the measurement of blood glucose levels to keep levels in the target range, inform administration of insulin and avoid extreme health events like hypoglycemia.
Traditional blood glucose monitoring that tests a blood sample from a finger stick at regular intervals throughout the day may not provide the support that working patients or caregivers need. Managing glucose levels isn’t only a concern for patients, but also for caregivers, such as parents who care for a child with diabetes. Some schools or daycares may not be willing or able to provide the support needed.
“Regular blood glucose tests only capture glucose levels at one point in time, but it does not provide the patient with the additional information of where their sugars have been or are heading,” said Siemens. “CGM provides better glucose monitoring for the patient and gives the clinician so much more information, such as glucose fluctuations throughout the day, which can be used to better manage insulin dosing to ensure not only efficacy but safety.”
A patient may not always be aware their glucose levels are dropping. “A CGM system has adjustable alarms, which can be used as an early warning system to notify patients and caregivers when levels are heading dangerously low or high and allows them to address the situation before it becomes an emergency,” said Siemens.
Patients using traditional finger stick glucose tests need a clean environment and access to their supplies, which may be a challenge in some workplaces, whereas a wearable CGM provides glucose level readings in any situation.
When patients rely on pharmacists to provide patient support, access to CGM in the pharmacy offers multiple advantages. “When we allowed pharmacies to direct bill, patients could receive their CGM where they get their insulin,” said Mistry.
“I am authorized to prescribe diabetes medication and having access to a 24/7 glycemic profile provided by CGM technology is crucial in ensuring proper medication selection and appropriate follow up,” said Siemens.
Although CGM may seem expensive, “strips are also expensive, especially if they are used as often as needed (8-10 tests per day) to manage complex diabetes regimens and cost effectiveness studies have demonstrated that CGM pays off in the long run,” he noted.
The upfront costs of CGM may be challenging for a patient and deter them from using CGM. But direct billing, “allows us to provide the patients with tools when they are motivated to improve their diabetes management,” said Siemens.
According to Mistry, when PreferredOne transitioned coverage for CGM from the medical to the pharmacy benefit, “we generated over 50 per cent savings and simplified our processes. We now use our [pharmacy benefit management] system to manage the CGM benefit, which has better technology and allows us to use smart edits to automate the processes.”
The organization implemented an automated prior authorization process whereby, if a patient had a prior claim for insulin, they’d be approved and would be able to pick up their CGM in the pharmacy. “The new process was a win/win,” said Mistry. “The plan saved money and we had happier patients.”