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Yesterday I started using a Continuous Blood Glucose Meter (a Dexcom G4 Platinum).

I'll blog again once I've got more experience in day to day use. I've got good reason to believe it will make an astonishing difference to my diabetes management in terms of my daily life and my clinical outcomes.

First up, however, I'm going to blog about their cost.

  • There's more than one Continuous Blood Glucose Metering System (CGMS) available, and there are differences in cost.
  • There are two ways of getting one in Australia: persuade someone (eg a Diabetes Education Centre) to loan you one, or buy one yourself.
  • Medicare won't pay for your CGMS or its supplies
  • The National Diabetes Supply Scheme won't pay for your CGMS or its supplies
  • Private Health Insurance won't pay for your CGMS or its supplies

There's not a lot to love about the way that access to health care is organised in the US, but this is a rare case where I'd be better off as an employee covered by a good US Health Insurance scheme, because there would be a good chance my CGMS costs would get covered in the US. I think there is a very strong case for subsidising CGMS in Australia, but  it's a very hard ask.

Hardware/Supplies


In my case there are two pieces of hardware (prices are likely to vary as temporary price offers are introduced or expire):
  • the Receiver: AU$810. In theory this can last forever.
  • a Transmitter: AU $595. In theory this will last at least 6 months, but I expect longer.
  • Sensors: AU$396 (currently for 5, but list price that's the cost of 4). In theory each sensor lasts 7 days.

Justifying the cost


I'm glad the cost of the Receiver/Transmitter has come down from the cost of previous generations of these devices (many thousands), because I can cope with the upfront cost. The Sensors will have an eye-watering effect on the family budget. I justified it as follows: Running this system is roughly comparable to supporting a smoking habit of about a packet of cigarettes per day. People on all sorts of income levels manage to pay to support a habit that destroys their health.

Surely I can pay a similar amount for something that will improve my health?

When we discussed using CGMS my endocrinologist said "If it didn't cost anything, we'd have every type 1 diabetic on CGMS".

Standard blood glucose monitoring (using fingerpricks) was expensive when it arrived in the early 1980s: $600 for a meter and about a dollar per test strip. These days the meters are about a hundred dollars (and often given away) and the strips are $0.60 per strip(*) without a subsidy and less than twenty cents per strip with the subsidy. (People do anything from four to 14 tests per day.) Following the adoption of standard blood glucose monitoring, the health outcomes for people with diabetes have been steadily improving.

There is a measurable improvement in diabetes control with CGMS. The easiest measurement is the HbA1c level - an 'average' of your control over a period of 3 months. It's a rough measure of control, but the easiest one to get. It appears clear that CGMS improves HbA1c levels. See this article in the New England Journal of Medicine.

Epidemiologists and Health Economists will probably decide for a while to come that the size of the HbA1c benefits are not sufficient to justify a large new subsidy under the National Diabetes Supply Scheme.

There's another measure that is of interest: Glycemic Variability. How much does a person's blood glucose levels fluctuate? I have an excellent "average" (HbA1c) level, but I know from my own records (numbers copied into spreadsheets!) that I only spend about 50% of my time in a normal glucose range. Averages can be very deceptive!  Until CGMS arrived, it was hard to measure people's Glycemic Variability because most people don't do fingerprick blood glucose tests often enough to be statistically useful. So there aren't many large scale studies on how important it is for long term survival and avoiding complications. The evidence is starting to suggest that it is important. See this study. When these studies multiply (and maybe costs come down), CGMS might justify a subsidy.

The other factor that OUGHT to be considered is the degree to which CGMS improves daily life. It's too early for me to speak from my own experience, but I have reason to expect the following benefits:
  • A protection against Hypo (low blood sugar) unawareness (I only sometimes feel symptoms when my blood sugar drops to dangerous levels)
  • ... (remembering of course, that from time to time people with diabetes die from acutely low or high blood glucose levels)
  • a reduction in the number of times I feel "tired" (and unproductive) as my blood glucose goes up or down - improved quality of life (and, for the economists: economic productivity!)

(*) Update 22nd May 2013: In an earlier version of this blog posting, I made a silly mistake calculating the cost of blood glucose tests strips. The incorrect costs I originally posted of 6 and 2 cents have been changed to the correct figure of sixty cents per strip (retail) and less than twenty cents per strip (after NDSS subsidy).

Comments (4)
Anthony Holmes May 10th, 2013 09:17:22 AM

 Comments
1) Continuous Blood Glucose Monitoring in Australia
Tricia 10/05/2015 1:11:44 PM

Thanks for the information. I was looking at this and from initial searches of other providers it looked like it ran in conjunction with the insulin infusion pumps.

Just a question, are you a type 1 diabetic? Obviously this would be of great benefit, but I was also wondering if it would have benefit for type 2 or gestational diabetics as well.

With thanks,

2) Continuous Blood Glucose Monitoring in Australia
Anthony Holmes 10/05/2015 1:19:13 PM

I have type 1 diabetes. Here's what I imagine someone with type 2 might consider:

If you weren't being treated with insulin a sensor may be interesting to let you see how eating and lifestyle changes could reduce your times with high blood glucose levels: For example:

* Is it better to go for a brisk walk early in the morning, in the afternoon, in the evening?

* How does a pasta meal affect me compared to a meal with rice? Different serving sizes? Pizza? etc.

Perhaps this is a case where borrowing a continuous monitoring system for a couple of weeks might be useful (if you can find somewhere like a diabetes education centre that does this?)

If you are a person with type 2 diabetes on insulin you'd eventually see similar benefits to someone with type 1 diabetes, especially if you reached a point where hypos were a concern.

Now that I've been using the system for a couple of years the benefits to me are:

1. I no longer need to be worried about the risk of having a hypo without realising it. (This is especially good if I happen to be alone.)

2. I can avoid going high for long periods of time without realising it (for example, overnight).

3. I can see the direction and **speed** of my blood glucose going up or down.

3) Continuous Blood Glucose Monitoring in Australia
Kimberlie 3/06/2015 1:38:47 AM

I'm not diabetic - I have hyperinsulinemia - so I'm not covered AT ALL for diabetic supplies etc... I suffer from hypos quite frequently (most of the night) and have been trialing Victoza injections with limited success for about 6 months - this is also NOT covered in any way by medicare and with very little support from private health insurance - for a medicine NOT actually approved for my condition...

It's taken 6 months just to get to a point where the hospital can do a CBG test again (my second one) to examine how the Victoza is or isn't working for me - apparently I'm not a priority (their words not mine) as I am not diabetic - even though I suffer from potentially similar outcomes - ie hypos with disastrous outcomes... no offense intended towards people with diabetes - just frustrating that my condition isn't equally important.

My friend is a nurse and she wondered if I should get a CBGM - but I can't see where, how, who, what etc I could go about that...? I can't find pricing, suppliers - do I need a prescription? or referral? or what? Your blog is the most information I can find - and I was hoping (crossing fingers) that based on your price guide (a few years ago?) that costs have come down? or are more easily accessible?

I just want to get the hypos under control - I don't want to end up with them taking most of my pancreas out - I don't want the 8 hours of sleep time where I have most of my hypos to keep going on - I don't want to feel so rubbish all the time - maybe the CBGM would help me find a better control level in being more aware when my levels are dropping...? (I don't have hypers)

Sorry - a lot of questions and a lot of rambling... any advice/suggestions/knowledge would be greatly appreciated... I realise the conditions are not the same - but there are similarities. Many thanks.

4) Continuous Blood Glucose Monitoring in Australia
Anthony Holmes 3/06/2015 10:26:58 PM

Hi Kimberlie

Prices (for the Dexcom) have remained the same.

To get started you need something that is called a prescription: really it's a letter from your doctor/specialist to the Australian distributors of Dexcom ( http://www.amsl.com.au ) telling them that it's appropriate for you to use CGMS. After your initial training you can keep ordering supplies without further "prescriptions".

AMSL have a person or two in each state whose job (at least partly) seems to be to help guide people through the steps needed to get onto CGMS. Look up AMSL's general number for diabetes (I know, you don't have diabletes!) and with luck they may be able to offer some suggestions.

I can only imagine how you're affected by your hyperinsulinemia: being regularly low is no fun. I presume you feel tired, can't think straight and have a whole bunch of other bad symptoms. I bet there are triggers in your daily life that you'd understand better if you could see what was happening and avoid long drawn out lows.

However: one warning about CGMS. When I go low and I have sweets to treat it, the Dexcom is slow to recognise that I've come back up to a normal level. Often 20-40 minutes after I've eaten the Dexcom warns me (correctly) that I'm low, but after I've eaten glucose I see that it still thinks I'm low: a standard blood glucose test tells me that the sweets I've eatern have done their job and I'm back up rising to 4, 5, 6 + mmol/l. It's important to realise that the Dexcom needs to be used with a Glucose meter to check its values from time to time.

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