Lifestyle

Vladimir Regional Health Department Identifies Diabetic Children Who Do Not Need Continuous Testing in Order to Economize 135 Million Rubles

According to the Acting Governor, such systems are not mandatory for the Ministry of Health standard

In the Vladimir region, health care leaders are discussing with the Ministry of Health the criteria for determining the need for continuous glucose monitoring systems for diabetic patients.

Some parents insist on providing their sick children with such devices. The White House, on the other hand, is not convinced that all patients need continuous monitoring. At a press conference on May 30, Acting Governor Alexander Avdeev said that 15 million rubles from the regional budget would be required to provide the machines only in the most severe cases, and 150 million rubles annually for a total purchase for all.

The head of the region demonstrated awareness of the problem and called the issue “of concern to everyone”. Alexander Avdeev raised this topic during the press conference on his own, in his introductory remarks. He also said that one of the companies producing continuous glucose monitoring systems provokes parents to demand the provision of devices, despite the fact that in some cases they do not have sufficient measurement accuracy:

“If it were fully spelled out in the norms and requirements of the Ministry of Health, they would have done everything long ago. But as it turns out, only by determining the best solution for a particular situation. The Ministry of Health itself admits: “Well, yes, some regions find [funding]. There are regions that are richer-they do. But I can say that, for example, Moscow, one of our richest regions, surprisingly does not buy NMG.

What do parents of children with diabetes refer to? There’s a standard. Previously, the standard A-090523 provided for testing blood glucose levels in 100% of cases. And test strips were prescribed. You know, they are prescribed [and now], they are prescribed to everyone. Controls two, four, six times a day. It’s a classic control: test strip, puncture, glucometer sensor. Then you add this item 001 as an additional measure that doesn’t cancel the test strip. [The standard says:] testing blood glucose levels, the key word being “in the blood,” by continuous monitoring. Then there are the mass appeals, I can honestly say, fueled by the FreeStyle Libre manufacturer, that “here, they provide [not all children]…”

Let’s read what is written in the certificate for this device: “The scanner is used in conjunction with a sensor, designed to measure glucose levels in the interstitial (intercellular) fluid in patients. That’s subcutaneous fluid, it’s not blood. Moreover, I will say that we have examples when a family purchased such a device for a child, and within a year the child’s situation worsened. Because it does not give 100% correlation of insulin therapy. Only a blood test gives more accurate readings. Moreover, here it is not here, but in another paragraph [it says that] this sensor is not used for children under the age of four. Only older ones. That’s where all the fuss comes from. Somebody demands this particular sensor, and it’s not designed for blood tests. The footnotes about ‘and by saliva’… How do you interpret them?”.

According to Alexander Avdeev, there are now 470 children with diabetes in the region. 10% of them received free continuous monitoring systems, as they are clearly indicated for such patients. About the neediness of the rest – the question is ambiguous:

“Out of about 470 children who have this diagnosis, we have 46 children who are constantly monitored and receive insulin therapy with pumps, [use] continuous monitoring sensors and so on. Continuously since 2013, those who definitely need it are using it. Continuous glucose monitoring itself is necessary for those who have unstable sugar. There is a glycemia that makes life more depressing. Some are tolerated in a milder form, they do not need continuous monitoring. Moreover, continuous monitoring does not cancel the point about testing blood glucose levels with test strips.

We are now in the study of this process and in consultation with the Ministry of Health to determine who needs what, whether it is possible to change blood tests to intercellular fluid tests. Once again, if there was a standard and everyone had to do that, everyone would have procured everything a long time ago. Just to be clear – the cost of the issue, depending on the decision, ranges from 15 to 150 million a year, if you buy all the sensors who are supposed to and who are not supposed to.

There is another thing. There is also a list by the Ministry of Health, but they [continuous monitoring systems] are not on the list. To put it simply, when you are sick and you go to the hospital, you must be prescribed medicine for free that is on the list. You are prescribed analgin, you go to the pharmacy and they give it to you for free. If you want to buy pentalgin or baralgin, you have to pay for it. It is the same in this case. If you are entitled to free test kits, strips – it’s free, and it’s in the standard and list of the Ministry of Health. If you want to measure sugar levels in another way, and you have to read the description from the manufacturer, then it is already at your expense. Nevertheless, 46 children in our country constantly use this, <…> (unintelligible) other sensors from another manufacturer, and so on. And we’re going to work out our own internal standards now, which children and adults are entitled to. Indeed, there are some indications where it is better to have continuous monitoring. That percentage needs to be looked at by clinical indications.

The price of the issue is from 15 to 150 million rubles a year. Where can we just get it? If someone could tell me, I would be grateful.

Procurement of continuous glucose monitoring systems is not the only problem that worries parents of diabetic children in the Vladimir region. At present, the regional health authorities are experiencing difficulties with the purchase of Accu-Chek insulin pumps. Artem Osipov, the acting head of the Regional Health Department, told about this during his speech to the deputies of the Legislative Assembly.

The head of the Regional Health Department stated that not only Vladimir, but also the neighboring Ryazan and Moscow regions faced a shortage of insulin pumps. Doctors in the capital urgently seek an alternative way to provide medical care for children.

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