GPs can approve continous glucose monitors but not for everyone

And an expert warns that while the move is a win, using the technology effectively comes with challenges.

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GPs can now approve access to subsidised continuous glucose monitors for Department of Veterans’ Affairs (DVA) card holders, despite the National Diabetes Services Scheme continuing to block the same access path for non-veterans. 

As of this month, GPs, diabetes educators, registered nurses and other specialists can approve the initiation of a subscription to a CGM via the DVA’s Rehabilitation Appliances Program (RAP) by completing a product order form. 

All gold and some white DVA card holders are eligible. 

Prior to the program, initial authorisation required signing off from an endocrinologist.  

For non-DVA card holders, the NDSS only allows subsidised access for type 1 diabetics and currently blocks GPs from approving access, a position hotly contested by the RACGP. 

Speaking to The Medical Republic, Australian Diabetes Society CEO Associate Professor Sof Andrikopoulos said that diabetes technologies, including CGMs, can have “huge benefits” both clinically in managing HbA1c and from a quality-of-life point of view, by enabling proactive, self-management of blood glucose levels. 

But while having access to the technology is a win, using it effectively is another kettle of fish, added Professor Andrikopoulos. 

“The technology itself will not give you better management of your diabetes, it’s the application and appropriate use of it that can,” he said. 

According to Professor Andrikopoulos it is important that whoever is signing off on the CGM is capable of managing the patient.  

This includes understanding the glucose patterns and how to manage medication and lifestyle changes to improve outcomes. 

All health professionals signing off on CGM access, particularly for veterans, should seek out additional education or ensure they have a at the ready a suitable referral pathway to a diabetes specialist, endocrinologist or credentialled diabetes educator, said Professor Andrikopoulos. 

“In saying that, the ADS has on its website, a number of resources specifically written for GPs that can assist in implementing this type of technology,” he added. 

Professor Andrikopoulos pointed GPs to the Ambulatory Glucose Profile statement and the Glucose Pattern Insights report consensus statement for support in helping patients monitor their glucose. 

“[The ADS] strongly recommends that GPs upskill,” he said.  

“This is technology that is evolving quickly… even specialists are having a hard time keeping up.” 

Commenting on whether the NDSS will follow suit by allowing GPs to approve CGM access for non-DVA card holders, Professor Andrikopoulos said “we’re going to have to see how this evolves”. 

Veterans are a predominantly older population that may have an increased burden of other comorbid chronic diseases, such as chronic heart failure, hypertension, chronic kidney disease, etc, said Professor Andrikopoulos. 

“Older people may be more prone to hypoglycemic events, particularly if they’re on insulin or sulfonylureas,” he said. 

“Having a CGM may provide them with added safety and comfort in managing their blood glucose levels, as an added security measure.” 

But it is especially important that the technology is applied appropriately and safely to negate any heightened risk of hypos, Professor Andrikopoulos cautioned. 

“We don’t want older people falling,” he said. 

“If they fall, they fracture and that often puts them on a slippery slope.” 

Veterans subscribed to the RAP program will receive a rolling supply of sensors every three months, delivered to their home. 

Insulin pumps, which are also available through the scheme, will still need to be signed off by an endocrinologist for the first order. 

Replacements for both pumps and monitors can be prescribed by a GP.