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Editorial “Many people with the poorest diabetes outcomes are those of low socio-economic status and marginalised groups who are likely to not have private health insurance.” funding constraints that limit access for some people. Also in this issue This issue also includes a CPD module on peripheral arterial disease screening. Read the article on page 16 and then go to www.pcdsa.com.au/cpd to complete the 10-question module. After completing the module you will receive a certificate that can go towards your continued professional development. There is an additional article on page 25 on antimicrobial infection of foot ulcers in people with diabetes by Roy Rasalam, Caroline McIntosh and Aonghus O’Loughlin. Ralph Audehm and Laura Dean provide a practical guidance on using and initiating glucagon-like peptide-1 analogues in people with type 2 diabetes (page 35), and there is an interesting, practical article on the role of a readily available, but under-used medication, fenofibrate, a cholesterol-lowering drug. This issue’s From the Desktop is by Gary Kilov, who provides the practitioner, and patient, perspective on flash glucose monitoring on page 7. n Australian Institute of Health and Welfare (2012) Diabetes. Australian Government, Canberra, ACT. Available at: http:// www.aihw.gov.au/diabetes/prevalence/ (accessed 10.08.12) Deloittes Access Economics (2014) Benefits of Credentialled Diabetes Educators (CDEs) to people with diabetes in Australia. Australian Diabetes Educators Association, Canberra, Australia Ellis SE, Speroff T, Dittus RS et al (2004) Diabetes patient education: a meta-analysis and meta-regression. Patient Educ Couns 52: 97–105 Holman RR, Paul SK, Bethel MA et al (2008) 10-Year follow-up of intensive glucose control in type 2 diabetes. New Engl J Med 359: 1577–89 IDF (2015) IDF Diabetes Atlas (7 th edition). International Diabetes Federation, Brussels, Belgium Lee CMY, Colagiuri R, Magliano DJ et al (2013) The cost of diabetes in adults in Australia. Diabetes Res Clin Pract 99: 385–90 Minet L, Maller S, Vach W et al (2010) Mediating the effect of self-care management intervention in type 2 diabetes: A metaanalysis of 47 randomised controlled trials. Patient Educ Couns 80: 24–41 Norris SL, Engelgau MM, Narayan KMV (2001) Effectiveness of selfmanagement training in type 2 diabetes: a systematic review of randomized controlled trials. Diabetes Care 24: 561–87 Norris SL, Lau J, Smith SJ et al (2002) Self-management education for adults with type 2 diabetes: a meta-analysis of the effect on glycemic control. Diabetes Care 25: 1159–71 Si D, Bailie R, Wang Z, Weeramanthri T (2010) Comparison of diabetes management in five countries for general and indigenous populations: an internet-based review. BMC Health Services Research 10: 169 6 Diabetes & Primary Care Australia Vol 2 No 1 2017
From the desktop From the desktop Patient and practitioner: Flash glucose monitoring Gary Kilov I have been caring for people with diabetes for about three decades, which is similar to the length of time that I have been living with type 1 diabetes. It would, therefore, come as no surprise that I have a vested interest in keeping abreast of the latest developments and innovations as they pertain to the management of diabetes – specifically, any progress that improves quality of life and eases the burden of living with diabetes. When I am fortunate enough to be offered the opportunity to try out some of the more innovative new products, I jump at the opportunity, and such was the case with the FreeStyle Libre Flash Glucose Monitoring System (Abbott Diabetes Care, Alameda, California, USA). Among the most significant advances in diabetes management in recent decades has been the progress in glucose sensing. For over 2000 years, urine tasters were trained to detect glycosuria (Kirchoff et al, 2008); that is, until the the first half of the 20 th century, when chemical reagents took the place of taste buds to detect glucose in urine. Since then, the pace of change has been rapid, progressing from testing urine with tablets or strips to measuring glucose in blood. Regular, frequent blood glucose level (BGL) testing is essential for patients on multiple doses of insulin to guide dosing and optimise glycaemic management whilst mitigating hypoglycaemia. Until recently, the gold standard for BGL sensing for most of our patients has been self-blood glucose monitoring using fingerprick testing. Despite significant improvements in this technology, several limitations remain. Finger-prick testing is inconvenient, painful and gives only a momentary snapshot in time, falling short of providing a comprehensive profile of dynamically changing BGLs. Ideally, continuous monitoring of BGLs should be more widely available for people with diabetes as emerging data supports its effectiveness in maintaining glycaemic control, and international professional organisations endorse it as the gold standard for those with type 1 diabetes (Endocrine Society, 2016). Since the turn of this century, access to continuous glucose monitoring (CGM) has been steadily increasing but significant limitations and barriers remain. It is more costly than traditional blood glucose monitoring and is, therefore, limited to a small cohort of patients, usually those with type 1 diabetes using insulin pumps and to whom the cost has not been a barrier. Over time, the affordability of CGM devices has improved and the entry of new players into the space has resulted in gradual, but steadily increasing access. However, it is only with the release of the FreeStyle Libre that we have seen a democratisation of this space with the device promoted to healthcare providers, but firmly marketed directly to consumers who have driven the demand. As clichéd as this may sound, this has been a game changer. The FreeStyle Libre provides greater accessibility for consumers and, not surprisingly, has proven very popular. The system has been available in the UK and Europe for almost 3 years, while in Australia it has been available for several months. By all accounts so far, it has proven to be just as popular here as in the northern hemisphere. So what does it do? The FreeStyle Libre offers flash glucose sensing. What this entails is the application of a sensor (which lasts for 2 weeks before requiring a replacement) to the upper arm Citation: Kilov G (2017) Patient and practitioner: Flash glucose monitoring. Diabetes & Primary Care Australia 2: 7–9 About this series The aim of the “From the desktop” series is to provide practical expert opinion and comment from the clinic. In this issue, Gary Kilov gives a first-hand patient and practitioner perspective on using flash glucose monitoring. Author Gary Kilov is Associate Editor of Diabetes & Primary Care Australia, and Director at Seaport Diabetes, Launceston Area, Tas, and Senior Lecturer at University of Tasmania, Launceston, Tas. Diabetes & Primary Care Australia Vol 2 No 1 2017 7
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