CGM for Diabetes on the Rise in Italy, but Usage Is Still Lower Than Expected, Study Says

Children with type 1 diabetes had the highest rates of using continuous glucose monitoring and continuous subcutaneous insulin infusion in Italy, according to recent research, but economic barriers prevent widespread adoption.

Usage of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) for type 1 diabetes (T1D) increased in Italy between 2013 and 2018, but uptake is still lower than what is expected, according to a recent study.

A 2013 survey of diabetes care centers showed that only 23% of adult centers and 53% of pediatric diabetes units had a care team dedicated to diabetes (including a physician, nurse, dietician, and psychologist). Since then, technology in managing diabetes has grown and guidelines have been issued, so researchers conducted another survey in 2019, given that the prevalence of CSII use in Western Europe is 43% and CGM use is 46.4%.

Researchers conducted a web-based survey to evaluate health care facilities and the makeup of staff providing diabetes care. Sixty-one pediatric and 243 adult centers participated, accounting for 507,386 patients; of those, 10.4% had T1D; 86.4% had type 2 diabetes (T2D); 2.2% had gestational diabetes; and 1% had other types of diabetes.

Most of the centers were allowed to prescribe either technology, while 7.5% were not allowed to prescribe either type.

Only 53% of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists.

Overall, 13,204 patients (2.6%) were using CSII and 28,936 (5.7%) were using CGM, mostly for T1D.

By type of diabetes, 24% patients with T1D were using CSII, and 40.5% were using CGM. Patients with T2D and women with gestational diabetes had low usage rates of these technologies.

A little more than a third of adults with T1D (32%) used CGM, and 21% used CSII. Pediatric patients had higher rates of usage—35% used CSII and 57% used CGM.

Differences were seen across regions, with fewer patients with T1D using either technology in southern Italy compared with northern or central areas. There were no differences for patients with T2D.

Compared with 2013, there was an 8% increase in the use of CSII by patients with T1D. There was no reported use of CGM in Italy in 2013.

The authors cited several reasons as to why use of these technologies is lower in Italy, which has fewer economic resources compared with Western Europe. Fewer of these resources are dedicated to the health care system; the authors noted that the number of staff in pediatric diabetes centers is lower than what is suggested by guidelines.

In addition to a lack of diabetes care specialists, there is also a lack of dedicated nursing staff; studies have indicated that having dedicated staff can increase the level of metabolic control.

The mix of staffing is different in centers, with more psychologists and residents in pediatric centers, and more physicians and nurses in adult centers.

There was not enough information on dietician staff time in order for researchers to conduct an analysis.

Patients need education and training on these technologies in order for them to be used successfully, noted the authors, who called for “economic investment” in order to overcome the barriers to increased uptake of diabetes technology.

Reference

Pitocco D, Laurenzi A, Tomaselli L, et al; Working group of Diabetes and Technology AMD-SID-SIEDP. Health care organization and use of technological devices in people with diabetes in Italy: result from a survey of the working group on diabetes and technology. Nutr Metab Cardiovasc Dis. Published online July 14, 2022. doi:10.1016/j.numecd.2022.07.003