This document was published more than 2 years ago. The nature of the evidence may have changed.
Good control of the blood glucose level is vital to avoid diabetes complications. Blood glucose can be monitored by the patient using test strips (Self Monitoring of Blood Glucose, SMBG) or via a subcutaneous sensor (Continuous subcutaneous Glucose Monitoring, CGM). In type 1 diabetes, frequent blood glucose monitoring is required daily to achieve good glucose control.
Surrogate measures (such as HbA1c, C-peptide and glucose variability) are not evidence-graded, but are described in the report. In addition, HbA1c is reported in Appendix 3.
There are no comprehensive statistics on the use of continuous glucose monitoring either alone or in combination with insulin pump therapy (SAP) in Sweden. In order to chart practice of the use of these methods in specialist care more closely, a major study of practice was conducted that involved all the diabetes clinics in Sweden.
Continuous glucose monitoring costs approximately SEK 28,000 more per year and patient than self-monitoring of blood glucose using test strips. The additional cost depends on how many test strips can be reduced with continuous glucose monitoring compared to test strips alone. If continuous glucose monitoring is used in combination with insulin pump therapy (SAP), the annual additional cost increases by approximately another SEK 11,000 per patient. In order to calculate whether continuous glucose monitoring and SAP are cost-effective methods compared to injection therapy and test strips, the increased treatment costs need to be considered in relation to the long-term effects on the health of patients.
Diabetes is a disease that requires considerable patient effort both day and night in a very different way from most other illnesses. Other values than the medical effects must therefore be taken into account. The methods of administrating insulin and monitoring blood glucose have considerable impact on the individual patients and their families.
How to cite this report: SBU. Continuous subcutaneous glucose monitoring for diabetes. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2013. SBU report no 2013-04 (in Swedish).
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