DRWF Podcast: Why healthcare professionals are encouraging “technology over medication” for type 2 diabetes
The findings of a new report offered insights into access to care and perceptions of diabetes technology for people with type 2 diabetes, over traditional medications.
A recent survey has found that half of all healthcare professionals felt continuous glucose monitoring (CGM) should be the standard of care for people with type 2 diabetes whether they were using insulin to manage the condition or not.
The State of Type 2: Access and Attitudes Across Europe and the Middle East report was recently published by diabetes technology manufacturers Dexcom.
We previously reported how access to education and diabetes management technology will play a “vital role” in type 2 diabetes support and to find out more we talked to Adrian Gut, Senior Director of International Access, Advocacy and Value at Dexcom, for a DRWF Living with Diabetes podcast.
Adrian said: “With policymakers increasingly focused on digital transformation in healthcare, now is the time to push for greater investment in CGM technology as a core component of type 2 diabetes management.
“Enhancing CGM accessibility is crucial to tackling the type 2 diabetes crisis. By ensuring equitable access to this life-changing technology, we can empower people with type 2 diabetes to take control of their diabetes management, improve their quality of life and reduce complications. This will significantly improve public health outcomes and reduce long-term healthcare costs. Now is the time to make a transformative impact on the lives of millions.”
Claire Levy, DRWF Living with Diabetes presenter, said: “Dexcom's latest State of Type 2 report revealed that there are 61 million people with diabetes in Europe and 73 million in the Middle East and North Africa, with 90% of those living with type 2 diabetes. The report estimates rapid growth by the end of this year, with 69 million people living with diabetes in Europe and 136 million in the Middle East and North Africa. The growth of type 2 diabetes in the UK is also a growing concern. The latest figures indicate 4.3 million people live with all types of diabetes, with an additional 2.4 million at risk of developing type 2 diabetes.
“The research also looked at the impact of living with type 2 diabetes. Nearly two thirds felt challenged by the need to manage their diabetes day to day. Around a quarter avoided eating out, and almost a third admitted they did not know which foods impacted their glucose levels. However, four out of five respondents with type 2 diabetes said they would be receptive to having a CGM to help them manage their diabetes more effectively. Nearly two thirds said that poor management resulted in the development of one or more physical health conditions. Other questions revealed a high level of anxiety impacting various aspects of mental health.
“Interestingly, three quarters of healthcare professionals surveyed who faced challenges when caring for people with type 2 diabetes agreed that a CGM would help resolve these issues, and nearly all think CGM will become standard practice for caring for people with type 2 diabetes. So how are the report's findings being used by Dexcom?”
Adrian has been closely involved with the State of Type 2 report, which reveals the condition is not only on the rise in the UK but also across Europe, the Middle East and North Africa.
The multi-region report included survey figures from more than 2,500 people, made up of people living with type 2 diabetes and healthcare professionals, from Germany, Italy, the Netherlands, Saudi Arabia, Spain and the United Kingdom.
The report included recommendations for improving access to education and diabetes technology throughout, which Dexcom said “serves as a call to action for policymakers”.
The report suggested that 134 million people living with diabetes, of which 90-95% live with type 2 diabetes across Europe, the Middle East and North Africa, could benefit from access to continuous glucose monitoring (CGM) technology.
Key findings from the report included that “technology, not medication” could be the future of type 2 diabetes care.
Adrian said: “We were looking for people to share their experiences, their opinions about the treatment of type 2 diabetes today, about access to technologies, barriers related to technologies. And then also there was a small cohort which has used CGM. They shared their experiences, how it was, what were they expecting out of it as far as clinical outcomes, quality of life, wellbeing in general, and then how being on a CGM met this expectation.”
Asked what proportion of people living across Europe, Middle East, North Africa have type 2 diabetes, Adrian said: “In general, if you look at the total diabetes population, it is typically less than 10% have type 1 diabetes. Type 2 diabetes is by far larger in numbers of incidence and prevalence. The International Diabetes Federation (IDF) estimates that the total number of people with diabetes today in Europe is around 60 million. They expect this to grow over the course of the next ten years to more than 70 million people. It is a massive healthcare issue.”
The report revealed that 53% of healthcare practitioners in the UK think better access to CGM will most positively help patients with type 2 diabetes to better manage their condition within the next 10 years. Lack of patient access to CGMs was seen as a key issue when caring for patients by 43% of doctors in the UK and 36% in Europe, middle East and Africa. A similar proportion said they believed providing additional funding or budget for CGMs was needed to increase their use amongst patients living with type 2 diabetes.
Living with Diabetes: How can CGMs help in type 2 diabetes?
Adrian Gut: “CGM is a technology that is extremely well studied and well published. It has been studied extremely well, not just in Europe but across the globe. The results repeatedly show the same thing. Most importantly, it is reducing the average blood glucose level, which is measured by HbA1C, and so bringing average blood glucose levels down.
“CGM has shown in every population group you are looking at, whether in type 2 or type 1 diabetes, regardless of the treatment regimen they are on, the result is always the same. These people show significant reductions in HbA1C. If you have lower average blood glucose levels – better control – you reduce the risk of long-term complications. Long-term complications include cardiovascular issues, renal issues, problems with the eyesight etc.
“On the more personal side, the quality of life is better by having access to continuous glucose data. CGM has shown to keep people out of emergency rooms and be more productive in their life, more productive in their studies, depending on how old a person is. Over short and long-term benefits have been clearly demonstrated, and not just in Europe.”
Living with Diabetes: How does that then help healthcare professionals in their job?
Adrian: “First of all, as a healthcare professional, your first objective is that your patients are doing well and that you can help them, and CGM is a tool that really enables the healthcare professionals to better help their patients. Diabetes is often referred to as a data disease because glucose levels constantly fluctuate. There is data about insulin intake, about medication intake, about sleep activity, etc.
“CGM is giving that data to the healthcare professional, which means they can better understand what the problem may be and how to help these patients, how to make recommendations. On the other hand, for the person with diabetes to have these insights and to understand, for example, how different types of food are influencing their glucose levels, how stress may be influencing their glucose levels. How taking more, or less, insulin affects what's happening.
“It's a fantastic tool to learn more how the body reacts and what is also important is that a group a CGM can prevent a crisis, because CGM systems provide alarms, before the blood glucose goes too high or too low, the person is alerted and can do something depending on the treatment they are on. They could, for example, take an insulin injection, or go for a walk if the blood glucose is too high.”
Adrian added: “I have only been speaking about the person with diabetes and how it helps them. Usually, every person is surrounded by maybe on average, about 3 to 4 people, loved ones, family members, boyfriends, girlfriends, you name it, who are also, to some degree living with diabetes and having a CGM.
“For example, as a young parent, with a small child with type 1 diabetes, the safety that I can sleep. I have my phone next to the bedside table, which is connected to the CGM in case there is ever something happening. I get an alert, and I can manage the situation. If you compare that to a time before CGM, young parents were under a huge amount of stress and often getting up in the middle of the night, taking the blood glucose levels, checking if everything was fine. So, we're not only helping the individual with diabetes, but everybody around them as well.”
Living with Diabetes: It is all about information, isn't it? Information is king and the more people know and understand and do something about it, I think people feel given power it can make such a difference to their lives.
Adrian: “Information is key. If you read the report in detail, you will see that it is a big problem that a lot of people know quite little about diabetes. Even when they get their first diagnosis, they know quite little, many of them voice, let's be honest, a bit of a frustration that they wish they had more information about diabetes. They would more quickly learn more about diabetes and what to do, and how to, to live with it.
“One problem specifically with type 2 diabetes is there are a lot of misconceptions. A sense of urgency is often lacking. Decision makers sometimes fix the more urgent problems like type 1 diabetes and by doing that the longer-term complications are still growing, and we don't take care of them.”
Living with Diabetes: You don't want to frighten people in those initial stages when they are first diagnosed?
Adrian: “That's what healthcare professionals, especially diabetes educators, are specially trained for. You have to find the right mix to give a person the information that is relevant for them to help them and change their behaviour, adhere to the therapies that are recommended, but scaremongering is not the right approach and depending on the person may be counterproductive.”
Listen to the DRWF Living with Diabetes podcast interview in full over two parts here
Read the State of Type 2 Report
Read more about type 2 diabetes
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