VISUAL IMAGE OF PRISON HEALTH CARE
Interstitial glucose monitoring in people with diabetes
La monitorización de la glucosa intersticial en las personas con diabetes
Sofía Victoria Casado-Hoces
1
, Patricia Inglada-Infante
1
, Isabel Algora-Donoso
2
, Delia González-Tejedor
3
1Specialist Nurse in Family and Community Nursing. Madrid III-Valdemoro Prison. Madrid. Spain
2Doctor in Pharmacy. Pharmacist at Madrid III-Valdemoro Prison. Madrid. Spain
3Medical Specialist in Family and Community Medicine. Specialist in Psychiatry. Psychiatrist at Madrid III-Valdemoro Prison. Madrid. Spain
2013-6463-sanipe-25-02-80-es.pdf
Devices are now available that continuously measure the interstitial glucose of persons with diabetes. They have been shown to have a very positive impact on metabolic control of the disease, with blood sugar within acceptable ranges for a longer period and a significant reduction of low blood glucose, which makes for greater patient safety and comfort1
2
3-4.
These monitors are included in the service portfolio of the National Health System in Spain, and are currently financed for patients with type 1 diabetes5, type 2 diabetes6 and other insulin-dependent patients (monogenetic diabetes, cystic fibrosis, pancreoprivic diabetes and hemochromatosis), as long as they are receiving intensive insulin therapy and require more than 6 finger pricks a day.
A growing number of people are entering prison with these devices, which obliges professionals to familiarise themselves with how they work.
There are two types of continuous interstitial glucose monitors:
Real time continuous monitoring systems, with a sensor that includes a transmitter that continuously sends measurement data to the receiver, which is a mobile device, the use of which are restricted in prison.
Flash monitoring systems (Figure 1), where the sensor (Figure 2) does not include a transmitter. To obtain the complete glucose history the sensor has to be scanned with the reader at least once every eight hours (Figure 3). This system is the one used in prisons.
The data in both systems is downloaded to a digital platform where it is processed via logs and graphs (Figure 4). In both cases, a set of alerts can be programmed to warn the patient of hypoglycaemia and hyperglycaemia, amongst other options. This greatly improves patient safety.
The duration of the sensor is 6-14 days depending on the model. Wet skin and excess hair should be avoided when placing the sensor (Figure 5)7, because they can make adhesion more difficult; areas with lipodostrophy, scars and moles should also be avoided. A dressing is recommended to ensure that the sensor sticks to the skin, thus preventing incorrect measurements. If the patient has contact dermatitis, a protective hydrocolloid dressing or Tegaderm® dressing can be applied to the skin before the sensor is inserted8.
It should be borne in mind that when the blood glucose is stable for a period of time, there is a match in the readings for blood and interstitial glucose. If not, there is a delay between the interstitial and capillary of about 5-10 minutes. There are situations of greater instability in readings of interstitial glycaemia (postprandial period, exercise, first hours of sensor use, hypo and hyperglycaemia, etc.) that can lead to incorrect calculations of the insulin dose, and so a capillary glucose reading is recommended before making any further decisions. This measurement is also recommended in cases where symptoms appear that do not match the monitor reading.
Technological advances oblige us to keep constantly up to date. They also represent a challenge to the prison system, since there is the added obligation of making prison security compatible with the right of patients to receive the same services as persons in the community.
References
1. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016;388(10057):2254-63.
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2. Kröger J, Fasching P, Hanaire H. Three European Retrospective Real-World Chart Review Studies to Determine the Effectiveness of Flash Glucose Monitoring on HbA1c in Adults with Type 2 Diabetes. Diabetes Ther. 2020;11(1):279-91.
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3. Oskarsson P, Antuna R, Geelhoed-Duijvestijn P, Kruger J, Weitgasser R, Bolinder J. Impact of flash glucose monitoring on hypoglycaemia in adults with type 1 diabetes managed with multiple daily injection therapy: a pre-specified subgroup analysis of the IMPACT randomised controlled trial. Diabetologia. 2018;61(3):539-50. doi: 10.1007/s00125-017-4527-5.
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4. Liang B, Koye DN, Hachem M, Zafari N, Braat S, Ekinci EI. Efficacy of Flash Glucose Monitoring in Type 1 and Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Front Clin Diabetes Healthc. 2022;3:849725. doi: 10.3389/fcdhc.2022.849725
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5. Dirección General de Cartera Común de Servicios del Sistema Nacional de Salud y Farmacia. Resolución de 22 de julio de 2021 de la Dirección General de Cartera Común de Servicios del Sistema Nacional de Salud y Farmacia, por la que se hace público el acuerdo de la Comisión de prestaciones, aseguramiento y financiación de 29 de enero de 2021 sobre los sistemas de monitorización continua de glucosa intersticial en tiempo real en la cartera común de servicios del Sistema Nacional de Salud. Madrid: Ministerio de Sanidad; 2021. (Consultado el 21/04/23). Disponible en: https://www.sanidad.gob.es/profesionales/prestacionesSanitarias/CarteraDeServicios/ContenidoCS/docs/Resol_MCG_TR.pdf
[ Links ]
6. Dirección General de Cartera Común de Servicios del Sistema Nacional de Salud y Farmacia. Resolución de 28 de octubre de 2022 de la Dirección General de Cartera Común de Servicios del Sistema Nacional de Salud y Farmacia, por la que se hace público el acuerdo de la Comisión de prestaciones, aseguramiento y financiación de 21 de julio de 2022 en relación a la priorización de pacientes con diabetes mellitus tipo 2 que realicen terapia intensiva con insulina y requieran realizar al menos seis punciones digitales al día para la auto-monitorización de la glucosa en sangre, a los que facilitar los sistemas de monitorización de glucosa. Madrid: Ministerio de Sanidad; 2022. (Consultado el 21/04/23). Disponible en: https://www.sanidad.gob.es/profesionales/prestacionesSanitarias/CarteraDeServicios/ContenidoCS/docs/Resolucion_Priorizacion_Colectivos_DM2.pdf
[ Links ]
7. Tutoriales y descargables. Sistemas FreeStyle. FreeStyle.abbott/es. Abbott. Disponible en: https://www.freestyle.abbott/es-es/ayuda/tutoriales.html?gclid=EAIaIQobChMIiqb6nL6-_gIVgeh3Ch1eDA76EAAYASAAEgI04_D_BwE
[ Links ]
8. Navarro-Triviño FJ. Reacciones cutáneas a sensores de glucosa: presente y futuro. Actas Dermosifiliogr. 2021;112(5):389-91. doi: 10.1016/j.ad.2020.09.008
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