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Saturday, April 13, 2024

Monitoring is also treatment

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Interview with prof. The doctor lived. doctor Leszek Czupryniak, head of the Department of Diabetology and Internal Medicine at the Medical University of Warsaw.

Monitoring your blood glucose levels is the first and important step to controlling diabetes. Why?

The essence of diabetes is the persistence of elevated levels of glucose in the patient’s blood, which in untreated or poorly treated people can lead to damage to the heart, blood vessels and peripheral nerves and, as a result, serious complications such as vision problems, impaired kidney function and premature death . Therefore, medications used in patients with diabetes are designed to lower and stabilize blood sugar levels. The thing is that when treating with insulin (which the patient administers himself), it is easy to “overestimate” it – the glucose concentration can fall too low, and this can even endanger a person’s life.

Blood glucose levels rise after eating, as well as under the influence of daily activities, illness, fever and painful menstruation. On the other hand, for example, running quickly to the bus involves burning a large portion of glucose; then hypoglycemia occurs. The body of a healthy person copes well with such situations – a sudden release of insulin – but a diabetic does not. In patients with diabetes mellitus, glycemic control must be regulated with medications – tablets or drugs (for example, GLP-1 analogues or insulin) by injection. The patient’s job is to know, after receiving the doctor’s and nurse’s instructions, how much insulin to take before eating or going to the gym, pool, bike ride, or dance party—that is, before a scheduled workout. He should then check his glucose levels and, if they are too low, eat something (to compensate). Monitoring blood glucose levels is a key element of proper therapy – for us doctors, it confirms that the patient is being treated effectively and gives the patient a sense of security that their blood sugar levels will not drop too much.

What role do monitoring systems play in glycemic control? Are patients ready to use them?

Due to the increasing cost of continuous glucose monitoring (CGM) systems, an increasing number of patients are able to better understand their disease and engage in treatment, since these systems are also a valuable educational tool that allows the observation of specific behaviors (physical activity, type of food consumed, or drinks) affects sugar levels.

Glycemic monitoring systems are modern tools that increase the efficiency of contacts between patients and their relatives with doctors and nurses, and also help improve the quality of patient care. They are of value to the entire healthcare system.

What is the essence of their work?

The first systems appeared 20 years ago. Initially, we thought that they would only be used for scientific research, to measure sugar during medical experiments. But when the FreeStyle Libre system was introduced to the market a few years ago, it proved to be an excellent therapeutic tool. Today we have a new generation of this system – the FreeStyle Libre 2. The patient wears a glucose sensor on the back of their hand (with a 3mm protrusion that measures sugar in the interstitial fluid), which sends blood sugar information to their phone every minute. It works completely automatically. In addition, the system alerts the patient when sugar levels are too high or too low, so the patient can adjust the insulin dose accordingly or take steps to prevent hypoglycemia. Thanks to these systems, it is possible to completely eliminate severe hypoglycemia, which is always very harmful for the patient.

The device can be considered revolutionary in the treatment of diabetes.

We doctors are delighted with these systems. I use the comparison that living with diabetes is like driving a car, but measuring your blood sugar with a finger glucometer four times a day (which is a lot, because there are patients who do this at most once a day) is like if a person with diabetes only opened her eyes while driving, four times per trip, but with the FreeStyle Libre system connected, it was as if her eyes were open all the time. Patients also love using these systems. They are very convenient to use – you can take a bath, go to the gym or pool and function normally.

There are several glucose monitoring systems on the market, but the FreeStyle Libre is the cheapest, most patient-friendly, and easiest to break even.

Who is eligible for reimbursement for a glucose monitoring system?

All patients who take insulin at least three times a day, and from January this year also all pregnant women with diabetes. The patient spends 150 zlotys per month with compensation and 560 zlotys without compensation to use the system. Physicians who use CGM on patients quickly hear, “I can’t imagine living without a continuous glucose monitoring system.” I encourage every patient with newly diagnosed diabetes, either type 1 or type 2, to purchase a CGM, invest in it, and wear it for a month because it will help them quickly learn what helps them and what hurts them. i.e. what increases and what decreases glucose levels. He learns about the effects of what he eats, how physically active he is, the effects of stress and sleep on his glucose levels…

The number of people with diabetes is constantly increasing. Do you think it is worth considering providing access to glycemic monitoring systems to other patient groups?

Current policy requires that every patient taking rapid-acting insulin at every meal and long-acting insulin at night be required to use a glucose monitoring system. Moreover, it would be good for every patient receiving insulin – even one dose of long-acting insulin per day – to also have such a system, because any insulin therapy increases the risk of hypoglycemia. Of course, every pregnant woman with gestational diabetes should also use it. The optimal situation would be if CGMs were used by all diabetics. Thanks to this, each of them will be able to find out their blood sugar level without pricking their finger, will be able to adjust their diet, and doctors, having a complete picture of the patient’s glycemia, will be able to make more informed decisions regarding treatment, thereby preventing long-term complications. diabetes.

Who cares?

Type 2 diabetes, which affects 95 percent of people. patients, is that the blood glucose level increases more and more because the patient’s body produces less and less insulin. This increase in sugar occurs slowly and painlessly, i.e., asymptomatic.

I believe that the optimal situation would be if every person with diabetes had a constant understanding of their own blood sugar levels. Diabetes has been asymptomatic for a long time, which is why it is so dangerous and is called the silent killer. By using a continuous glucose monitoring system, the patient and physician know how the patient’s blood sugar concentration is increasing; It is not necessary to wait for serious symptoms – for example, deterioration of vision. Treatment can be changed in response to even small increases in glucose levels to prevent progression of the disease.

I believe that anyone who wants to know their sugar levels, wants effective treatment and wants to change their lifestyle should be able to use this technology.

The Growing Epidemic of Diabetes
In Poland, about 3.5 million people suffer from diabetes, of whom more than half a million do not know that they have the disease. This means that every eleventh person in our country suffers from diabetes. The significant increase in diabetes incidence in recent years is the result, among other things, of an increase in the number of overweight and obese people, including after the Covid-19 epidemic.

  • Diabetes
  • Prevention
  • Metabolic diseases
  • Opinions and interviews

Source: Wprost

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