Original Title: Analyse af anvendelse af glukosemonitoreringsmetoder til behandling af voksne patienter med type 1 diabetes

Authors' objectives: The Danish Endocrine Society advocates the use of sensor-based glucose monitors for all type 1 diabetes patients with an HbA1c level exceeding 53 mmol/mol. However, local economic factors and uncertainty about the clinical benefits and economic ramifications of sensor-based glucose monitor use have led to differing adoption rates across Denmark. The Danish Health Technology Council wished to assess the current evidence on the topic to make a recommendation on the use of sensor-based glucose monitors in the treatment of adult patients with type 1 diabetes.

Authors' results and conclusions: Clinical effect and safety: The Expert Committee concludes that sensor-based glucose monitoring offers significantly superior clinical outcomes compared to traditional finger prick methods. Supported by evidence, all measured outcomes show positive impacts with sensor-based glucose monitoring. Key indicators such as time in range (TIR), HbA1c levels, and reduction in non-severe hypoglycemic events demonstrate clinically relevant improvements. Additionally, sensor-based glucose monitoring shows a promising trend in reducing glycemic variability. The Expert Committee emphasizes the importance of findings related to TIR and HbA1c. Analyses on clinical effect and safety specifically focuses on sensor-based glucose monitors equipped with alarm functions. Patient perspective: The Expert Committee concludes that sensor-based glucose monitors offer notable benefits over the conventional finger prick method, alleviating some challenges associated with disease management. Analysis indicates that, despite their advantages, sensor-based glucose monitors are not without flaws, and experiences vary across various aspects of diabetes management, including glycemic control and social interactions. Nonetheless, the Expert Committee affirms the superiority of sensor-based glucose monitors, emphasizing their ability to improve flexibility in the daily life and promote healthier habits, and thereby contribute to an improved quality of life for patients with type 1 diabetes. Based on the analysis of the patient perspective, patient preferences should guide the choice of monitoring method, with sensor-based glucose monitors often preferred for their convenience and safety. Organizational implications: Despite unified clinical guidelines, the Expert Committee assesses that varying practices in sensor-based glucose monitor provision across Danish regions and municipalities exist, evidenced by differences in adoption rates. The Expert Committee notes that sensor deployment is occurring at a rapid pace. Analyses indicate that integration of sensor-based glucose monitors into type 1 diabetes treatment will influence patient-professional interactions and resource utilization, especially during the initial training phase of patients. Healthcare professionals widely endorse the use of sensor-based glucose monitors, highlighting benefits in glycemic management and patient engagement. Differing approaches to patient education may necessitate additional resources for training courses of healthcare professionals if sensor-based glucose monitor recommendation is implemented. Health economics: Based on the health economic analyses, the Expert Committee concludes that sensor-based glucose monitoring significantly enhances patients' health-related quality of life and clinical outcomes compared to the finger prick method. Economic evaluation indicates sensor-based glucose monitor dominance with lower costs (-DKK35,364) and higher effectiveness (1,670 quality-adjusted life years) over a lifetime horizon, reflecting long-term cost-effectiveness for sensor-based glucose monitoring over the finger prick method. A positive recommendation for use of sensor-based glucose monitors is estimated to incur a five-year budget impact of DKK143 million on a national level. The Expert Committee notes that the budget impact analysis solely considers regional expenses, overlooking potential reductions in municipal costs. It is emphasized that the analyses are based on current sensor-based glucose monitor consumption patterns, highlighting the potential for significant changes in results with alterations in sensor-based glucose monitor usage or pricing.

Project Status: Completed

URL for project: https://behandlingsraadet.dk/find-evalueringer-analyser/analyser/2021/anvendelse-af-patientnaer-diabetesteknologi

Year Published: 2023

URL for published report: https://behandlingsraadet-classic.azureedge.net/media/kj0nmbhm/recommendation-on-glucose-monitoring-for-the-treatment-of-adult-patients-with-type-1-diabetes.pdf

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Denmark

Organisation Name: The Danish Health Technology Council

Contact Address: Niels Jernes Vej 6a, 9220 Aalborg

Contact Name: Nikolaj Hellmuth Skak

Contact Email: nsp@behandlingsraadet.dk