Key Points
- Continuous glucose monitoring systems could replace finger prick testing for glucose level monitoring in diabetics.
- Pain, inconvenience and stigma may put people off carrying out regular finger-prick testing.
- Only those with type 1 diabetes are currently able to access subsidies for CGM systems.
Sharon Briggs has had type 2 diabetes for more than six years, but only in the past nine months has she come to truly understand her condition and how it has affected her health and wellbeing.
A sensor the size of a large coin fitted on her arm is what has made the difference.
The Yorta Yorta woman told SBS News that using the continuous glucose monitoring (CGM) sensors felt like “buying” herself extra years.
However, Briggs was only able to access the sensors, which need to be changed every two weeks, because they were provided as part of a free program at her local community health centre in Mooroopna, Victoria.
The sensors for continuous glucose monitoring are fitted on the arm and provide information to a device such as a mobile phone. Source: Supplied
The reality of life with diabetes
Monitoring glucose levels helps people with type 2 diabetes to respond through food, insulin, or exercise, to ensure their levels are stable and they remain healthy and feeling well.
The traditional method of tracking these levels was by pricking a finger and swiping blood onto a strip to obtain a reading via a monitor.
The frequency of these tests varies depending on an individual's situation, including what medication they take.
Not monitoring glucose levels can put a person with type 2 diabetes at risk of having low glucose, which can be dangerous.
Continuous glucose monitoring helps Sharon feel in control
During a six-month program, Briggs was provided real-time feedback on the glucose levels in her body via the sensors, which send real-time information to a device such as a mobile phone.
Previously, she had relied on self-administered prick tests to monitor her condition.
Briggs said the sensor had changed her life.
“I always felt like my diabetes controlled me, but I actually feel that I've got the power now to control my blood sugar levels,” she said.
Briggs told SBS News she felt as if using the sensor was “buying” her extra years, as an improved awareness of her glucose levels had helped her manage her diabetes and reduce lows and highs that would make her feel unwell and contribute to ongoing poor health.
Briggs’ maternal grandmother and her great aunt who raised her, both died from complications related to diabetes and she is well aware of the gap in life expectancy between Indigenous and non-Indigenous Australians.
“I’m in my late 40s and recently in our community we’ve had a lot of deaths and it freaks you out a bit when it’s your peers and they are dying from things like heart disease and complications from diabetes, it makes you care more about your health,” she said.
Briggs admitted that, prior to using the sensor, she did not test her glucose levels six times a day, as she had been advised, because it was inconvenient and gave her sore fingers.
Some patients are not managing their diabetes well
Briggs’ attitude to finger-pricking is similar to that of many others who diabetes educator and registered nurse Belinda Moore works with.
Belinda Moore says that, compared to continuous glucose monitoring, finger-prick testing provides limited insight into a person's ongoing condition. Source: Supplied
She said there were three main reasons for that.
“Number one: pain. Number two: inconvenience. And number three: stigma and shame,” she said.
“It's inconvenient and it also brings about a huge amount of shame, the healthcare professionals who are the policymakers are glazing over this, but the shame associated with having diabetes, not just for Aboriginal and Torres Strait Islanders with type 2 diabetes, but anyone with type 2 diabetes, the shame of pulling out your finger-prick kit is huge and people just are not doing it.”
However, continuous glucose monitoring systems can cost thousands of dollars a year.
Moore said the cost was prohibitive, but she made sure to make her patients aware of the technology.
“I always do, but the absolute majority, no one can afford it,” she said.
Australians with type 1 diabetes are eligible to apply for access to fully or partially subsidised glucose monitoring systems through the National Diabetes Service Scheme but those with type 2 diabetes are currently ineligible for the subsidy.
Last year, when the federal government expanded access to subsidies to those over 21 years of age with type 1 diabetes, Health Minister Mark Butler said the annual cost of the devices to patients would be reduced from $5,000 to $390.
People with type 2 diabetes need to monitor their blood sugar levels. Traditionally, this has been done with a manual finger prick a few times per day. Source: Getty / Science Photo Library
Benefits of real-time monitoring
Moore said the difference between finger-pricking and using sensors was that the sensors not only provided more information between finger-prick tests “it also gives us this extra component in the data called glucose variability.”
She said it was important to be aware of the ups and downs in glucose levels.
“To get those levels nice and smooth is all about adjusting medication and adjusting exercise and food intake and just life basically, if we can get those levels nice and smooth, we know that that's actually reducing the risk to developing diabetes complications,” Moore said.
“When we're finger-pricking we don't have that insight.”
She said that meant the sensors could be useful in the prevention of eye, kidney disease and cardiovascular diseases.
Moore said this would not only mean long-term savings to health budgets but would work to close some of the gap in life expectancy between Aboriginal and non-Aboriginal Australians.
Closing the gap
Moore said a disproportionate number of Aboriginal and Torres Strait Islander Australians are at a disadvantage due to not having access to CGM as First Nations Australians were three times more likely to develop type 2 diabetes than non-Indigenous Australians.
“For however long people have turned up to see their diabetes educator or their GP and they get told ‘you’ve got to do this, you’ve got to check your blood sugars, they have got to be in these target ranges,'” she said.
Moore described that as a paternalistic way of doing things and said providing greater access to the sensor technology would empower those living with type 2 diabetes.
“It's actually changing the psyche or the mindset without us always asking them, saying you’ve got to do this. It's actually making them realise the outcomes of their actions,” she said.
Moore said better management of glucose levels also improved emotional wellbeing, which could be impacted by spikes in levels.
While a spokesperson for the Department of Health did not say if there were plans to expand subsidies for CGM devices to those with type 2 diabetes, they said the department was monitoring the operation of the scheme that provides subsidies for those with type 1 diabetes “and collecting data in relation to the expanded eligibility cohort.”
“Access has been progressively expanded to support those people with the highest need,” the spokesperson said.
Hope for improved health outcomes
While Briggs would have loved to have continued using the devices to manage her diabetes, the community health program that provided them to her for free came to an end a few months ago.
“I'm confident if I was on the sensors longer, I would have gradually gotten myself off the insulin, I wouldn't have been insulin dependent and would have just been able to manage my diabetes through other medications,” she said.
Moore said some early studies had shown the use of the technology may assist in pushing diabetes into remission in some cases.
In an effort to continue to better manage her diabetes and overall health, Briggs is paying for sensors for two-week periods where she can and finger-pricking in between.
