Estimates from the International Diabetes Federation indicate that in 2021, the number of adults with diabetes in South and Central America was about 341 million. In Brazil, according to data from the same entity, the disease affects 10.5% of the population, which represents about 20 million people. Many of them need to resort to daily finger pricks to monitor glucose levels.
But the scenario may change soon because the flash glucose monitoring system has become increasingly common. Experts from various Latin American countries, including Brazil, have established recommendations for the use of this tool in monitoring glucose levels in patients with type 2 diabetes (T2D). The guidelines were published in May in Diabetology & Metabolic Syndrome.
The Flash System
The flash glucose monitoring system uses a sensor that is placed in the subcutaneous tissue and measures interstitial glucose, according to Marcio Krakauer, MD, an endocrinologist at the Brazilian Diabetes Society and one of the authors of the publication. It provides frequent and continuous readings without the need for finger pricks to obtain blood, which provides greater comfort and convenience to the patient. In addition, it provides a glucose trend, which helps identify patterns and variations over time.
"The flash system is mainly used in patients who require frequent and continuous glucose monitoring, such as those with type 1 or type 2 diabetes who use multiple insulin doses. It can indeed, in many cases, replace standard monitoring done by blood test, providing a less invasive and more informative alternative for glucose management," said Krakauer told the Medscape Portuguese edition.
How Many Readings?
In August 2023, Krakauer and 14 other specialists in endocrinology and internal medicine from Colombia, Chile, Peru, Mexico, Argentina, and Brazil came together to establish recommendations for the use of the flash system in patients with T2D. The result is this year's publication in Diabetology & Metabolic Syndrome.
They reviewed the existing literature on the subject, as well as available guidelines for system use. They also developed a tool with 17 items to draft the final guidelines. They also identified the strengths, opportunities, weaknesses, and threats related to the use of the flash system in patients with T2D.
The specialists reached a consensus regarding the number of daily readings necessary with the flash system for various patient profiles. For patients using oral antidiabetic drugs or basal insulin, the authors recommended an average of six readings per day (ranging from 5 to 14). Patients who use multiple insulin doses should take, on average, 10 readings per day (ranging from 6 to 20).
Furthermore, they recommended that a minimum of five daily readings be taken (ie, upon waking up, before each meal, and before going to bed). And if the patient engages in physical activity, readings should be taken before and after exercise.
Other recommendations pertain to the importance of individualizing care and promoting patient education to understand that the more readings, the better the glycemic control.
According to Krakauer, patients using multiple daily injections (MDI) need more daily measurements because they are more susceptible to rapid and significant glucose variations resulting from the frequent administration of rapid-acting insulin before meals. In addition, these patients need to monitor glucose more frequently to adjust insulin doses according to real-time readings, diet, and physical activity. Lastly, more frequent measurements help prevent episodes of hypoglycemia, which are more common in patients using MDI because of the use of rapid-acting insulin.
"In contrast, patients undergoing treatment with oral therapy or basal insulin have lower glycemic variability and, therefore, may require perhaps less frequent monitoring," said Krakauer.
Accessibility a Challenge
Despite the benefits of the flash glucose monitoring system and its growing use, it is still far from being a reality for all diabetes patients in Brazil.
According to Krakauer, accessibility remains a challenge. "The cost of the sensor and reader can be a barrier for many patients, although efforts are being made to increase its availability through private health programs and government initiatives," he emphasized.
The tool is not yet widely available in the Unified Health System (SUS). "There are some initiatives and pilot studies to evaluate its inclusion in the SUS, but so far, most patients using the system do so through private purchase or medical agreements," he said, adding that expanding access depends on public health policies and cost-benefit negotiations for the flash system to be accepted as a standard glucose monitoring tool.
The study in question received support from Abbott Laboratories from Mexico, one of the pharmaceutical companies producing a flash glucose monitoring system.
This story was translated from the Medscape Portuguese edition using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.