Access to antidiabetic treatment and patient self-monitoring

Abstract

Patient self-monitoring of blood glucose (SMBG) levels contributes to patient empowerment and optimisation of management of diabetes. The aims of this study were to: 1) Investigate the perception of patients with type 1 diabetes mellitus (T1DM) regarding SMBG and identify problems encountered when carrying out BG monitoring, 2) Assess the perception of patients on innovative self-monitoring practices, namely continuous glucose monitoring (CGM), and 3) study diabetes treatment available on the local national health service (NHS) and protocols on appropriate use of medicines, compare antidiabetic medicines available on the local market and assess the burden for patients if antidiabetic medicines are not present on the NHS formulary. A questionnaire on SMBG in English and Maltese language developed and validated in a previous study by Cassar to be completed by semi-structured interview was updated with the inclusion of a section on CGM. After ethics approval, the questionnaire was disseminated to T1DM patients ≥18 years recruited by convenience sampling from 15 community pharmacies; 3 from each of the 5 statistical districts in Malta. The NHS formulary was accessed and antidiabetic medications together with protocols for use were noted. Antidiabetic medications present in the private sector were then compared to medications available on NHS and economic burden was calculated. Seventy patients were interviewed; 38 were female and 52 had a duration of T1DM >5 years. The most frequent problems encountered with daily SMBG were painful finger pricking (n=37) and high cost of buying extra test strips (n=33). Five patients currently use a CGM device and 30 patients are willing to use a CGM device in the future. Forty-seven patients stated that time was a barrier for SMBG. Antidiabetic medication available on the private sector but are not available on the NHS include insulin degludec, insulin glulisine, glimepiride and sitagliptin. Patients are not adhering to the recommended daily schedule for SMBG for various reasons including access to test strips and time limitations. T1DM patients are entitled to 4 test strips a day for free on the national health scheme. Improving awareness and access to CGM is warranted to overcome the problems identified with SMBG. Patients requiring medications which are not available on the NHS are met with a heavy financial burden particularly when it comes to insulins