Flash Glucose Monitoring - Diabetes Canada

Flash Glucose MonitoringFlash glucose monitoring is a method of glucose testing that measures, displays, and continuouslystores glucose readings that are recorded automatically. It can be used by adults to make diabetestreatment decisions, including insulin dosing, without obtaining a blood sample from the fingertip(finger prick). This has the potential to improve blood sugar control and quality of life for people withtype 1 or type 2 diabetes, resulting in physical, social, and emotional benefits.A flash glucose monitoring system uses an externallyworn glucose sensor with a small filament insertedunder the skin of a person’s upper arm. Whenthe sensor is “flashed” or scanned with a separatetouchscreen reader device, it transmits the realtime glucose reading and information on the mostrecent 8-hour trend to the reader. If the person withdiabetes performs at least 3 sensor scans per daydiabetes.ca1-800-BANTING (226-8464)

at approximately 8-hour intervals, the flash glucosemonitor can record 24-hour glucose profiles. A sensorcan be worn continuously for up to 14 days.Blood glucose monitoring gives people living withdiabetes a more complete picture of their glucosecontrol, which can lead to better short and long-termtreatment decisions and health outcomes. It can helpthem identify when their blood sugar is trending down,which allows for appropriate and timely action to betaken to avoid hypoglycemia (low blood sugar). It canalso provide early indication of hyperglycemia (highblood sugar) over the course of the day and promptadjustments to medications, activity, and food intake tohelp achieve blood sugar targets.Regular testing of blood glucose is critical to effectivelymanage type 1 and type 2 diabetes when taking insulintherapy. Until recently, the standard way to test bloodsugar has been to obtain a drop of blood from a fingerprick and to get a blood glucose reading using a bloodglucose meter. This is called self-monitoring of bloodglucose (SMBG). SMBG has some drawbacks, includingthe pain of pricking one’s finger (up to several timesa day when using insulin therapy) and less thoroughinformation on blood glucose trends.Flash glucose monitoring avoids painful finger prickingand can provide comprehensive glucose data making itmore likely for people to remain in their recommendedblood sugar range. This helps people living with diabetesavoid short term complications like hypoglycemia.Even though there is provincial health plan coverage forflash glucose monitoring in Ontario and Quebec andamong most private insurance plans, the cost is still abarrier for many Canadians who rely on their provincialhealth plans for coverage and/or diabetes support.Flash Glucose Monitoring: The ClinicalEvidenceDiabetes Canada’s Clinical Practice Guidelinesrecommend that people with diabetes monitor theirblood sugar levels to ensure they remain within thetarget range. This helps to prevent cases of severe lowor high blood sugar. Hypoglycemia or low blood sugarcan be a life-threatening complication of diabetes.Diabetes Canada states that using flash glucosemonitoring will: Determine if glucose is high or low at a given time; Demonstrate how health behaviours and diabetesmedication(s) affect glucose levels; and Help the person living with diabetes and their healthcare team make changes to health behaviours andmedications that will improve blood glucose levels.Flash glucose monitoring systems can be used to helppeople with diabetes stay within their target glucoserange and to prevent hyperglycemia or hypoglycemia.1If used consistently, flash glucose monitoring has thepotential to prevent life-threatening emergencies. Flashglucose monitoring technology, which provides patientswith information about their glucose levels on an ongoingbasis, has been shown to reduce the time spent in lowglucose range and increases the time spent in the targetglucose range in adults with type 1 and type 2 diabetes.diabetes.ca1-800-BANTING (226-8464)

In addition, people using flash glucose monitoring reporta positive impact on their diabetes management andquality of life.Who uses flash glucose monitoring?There is evidence that flash glucose monitoring maybe beneficial for people with type 1 or type 2 diabetesaged 18 years and older.2 It is intended to replace bloodglucose testing.3,4The detailed benefits of flash glucose monitoring forsome patient populations are unclear because clinicaltrials often exclude children or people at high risk forcomplications. Flash glucose monitoring has not beenevaluated for use with other implanted medical devicessuch as pacemakers. It has also not been evaluatedfor use in pregnant women, or persons on dialysis.The data are continuing to emerge at a fast pace andrecommendations must be updated based on the newinformation.reimbursement for the flash glucose monitoring systemfor Ontario residents who manage diabetes with insulin.In Quebec the current coverage criteria for flashglucose monitoring sensors by RAMQ are for Quebecresidents 18 years or older managing diabetes withinsulin and with two years’ experience in diabetes selfmanagement.A flash glucose monitoring system typically costs close to 2,500 a year. The cost for each sensor is approximately 90 and the reader costs approximately 50. Eachsensor can be worn for 2 weeks (14 days) and the iOSand Android apps to read the sensor information onone’s phone is available for free. Many people cannotafford this cost out of their own pocket.Where can you get a flash glucosemonitor?Those interested in purchasing or learning more aboutflash glucose monitors available in Canada can contact*:www.myfreestyle.caDiabetes management should always be individualizedand people living with diabetes should work with theirhealth-care team to determine the medications, devices,and supplies that best support their needs.RecommendationsCost and coverage in Canada Flash glucose monitoring may be offered to peoplewith insulin-treated diabetes to decrease time spent inhypoglycaemia.Many private insurance plans provide flash glucosemonitoring coverage. However, public funding isonly currently available in Ontario and Quebec. TheOntario Drug Benefit (ODB) program provides publicDiabetes Canada recommends that: Provincial governments publicly fund flash glucosemonitoring for people with diabetes where there aredemonstrated improved health outcomes.* Diabetes Canada does not endorse or recommend one particular device.1. Diabetes Canada Clinical Practice Guidelines Expert Committee, Berard LD, Siemens R, Woo V. Monitoring Glycemic Control. Can J Diabetes. 2018 Apr;42Suppl 1:S47-S53.2. Health Canada. Regulatory Decision Summary - FreeStyle Libre Flash Glucose Monitoring System - Health Canada. April 2019. Available from: ision-summary-medical-device-detail.php?lang en&linkID RDS101513. Bolinder, J., Anutuna, R., Geelhoed-Duijvestin, P., et al. (2016). Novel glucose-sensing technology and hypoglycemia in type 1 diabetes: A multicenter, nonmasked, randomized controlled trial. Lancet, 388, 2254-2263.4. Haak, T., Hanaire, H., Ajjan, R., et al. (2017). Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulintreated type 2 diabetes: A multicenter, open-label randomized controlled trial. Diabetes Therapy, 8, 55-73.Last updated: January 2020diabetes.ca1-800-BANTING (226-8464)

In TheirOwnWords.Why did you choose flash glucose monitoring technology for yourdiabetes management?I love that the flash glucose monitor sensors are not obtrusive or difficult to apply,they generally stay on for a reasonable period of time, and I am still able to swimwith my daughter.How long have you been using flash glucose monitoring?Lindsey LeClaire,British ColumbiaI have been using a flash glucose monitor for about two years.What would you say to someone who is considering a flash glucosemonitoring?I would strongly recommend to anyone who is considering a flash glucose monitorthat they not be intimidated by new technology. I have type 1 and type 2 diabetesfriends from teens to seniors who use flash glucose monitors and are achievingbetter control and better health. I know that making changes to a diabetesregimen can be daunting – be courageous! Try flash glucose monitoring! If it doesnot work for you, finger pokes and testing strips will always be available.Why did you choose flash glucose monitoring technology for yourdiabetes management?Dave Davidson,OntarioI had used continuous glucose monitor sensors in the past and saw the potentialfor me but could not afford to use them. When the Freestyle Libre becameavailable to me, as an Ontario senior, funded by ODB this seemed like the timeto graduate from periodic finger pokes to gaining access to much better bloodglucose data. With access to this information, I’ve been able to make steadyimprovements in my A1c.How long have you been using flash glucose monitoring?Seven weeks.What would you say to someone who is considering a flash glucosemonitoring?You need to be aware of the limitations of this technology, it’s not as accurate asglucometer readings. Make a commitment to yourself to take advantage of theadded benefit this provides, it’s a lot more than no more finger pokes.diabetes.ca1-800-BANTING (226-8464)

Why did you choose flash glucose monitoring technology for yourdiabetes management?Dane Wilson,ManitobaI started using a flash glucose monitoring system when it first became availablein Canada. As I am insulin-dependent, using both rapid and long-acting insulin,I found that I was sticking myself several times a day to monitor my bloodglucose levels. Since I started using a flash glucose monitor, I can check my levelsnumerous times a day without having to constantly stick myself with the lancet. Iam also able to determine which foods cause by blood sugar to spike. The flashglucose monitoring system is quite expensive but being able to constantly monitormy blood glucose levels is worth the price.How long have you been using flash glucose monitoring?I have been using a flash glucose monitor for several years now, ever since itbecame available in Canada.What would you say to someone who is considering a flash glucosemonitoring?Anyone that is interested in using the flash glucose monitoring system, I wouldtell them that it is the best way to monitor your blood glucose levels at any timeduring the day or night. It is so handy and convenient that it is well worth themoney to invest in this system.Why did you choose flash glucose monitoring technology for yourdiabetes management?I choose the flash glucose technology for my diabetes management for manyreasons. It is a game changer! It has changed my life from bad to the best life that Icould achieve living with type 1 diabetes. It helps me achieve every goal that I set; Iam free of worrying about my blood sugar.Sigal Matasaro,OntarioI don’t have to poke myself every time to know my blood sugar numbers, I cancheck as many times as I need to make sure I am staying on the right track. I cansee my blood sugar trend and react immediately. I can see my estimated A1cwhich helps me prepare my plan to achieve my A1c target. I’ve been living withtype 1 diabetes for 17 years and this is the first time I’ve managed to stay on targetwith my A1c; it’s been below 5.5 for two years now.How long have you been using flash glucose monitoring?I have been using the flash glucose monitoring for two years.What would you say to someone who is considering a flash glucosemonitoring?In my opinion, this is the best device out there. It has changed my type 1 diabeteslife. I am in a full control of my disease, and by that I am adding more years to mylife. It allowed me to go to an Extreme Adventure, climbing a mountain, which Icouldn’t achieve without it since I was the oldest one who accomplished it!Continued on next pagediabetes.ca1-800-BANTING (226-8464)