Abstract
Over the past ten years, technology has been developed to the point, where it can enable continuous and efficient monitoring of blood glucose levels for patients with diabetes mellitus. The biggest step forward was demonstrated by biosensors, which, with a non-invasive approach, provide healthcare workers with the information required for good titration of insulin doses. We looked at the benefits of using biosensors in diabetes monitoring in terms of medical aspect and economic justification of replacing traditional test strips with biosensors. In this paper, we have shown potential benefits in terms of improving diabetes control, patient benefits, and how the medical benefit is collerating with the economic viability of biosensors use. On the territory of Bosnia and Herzegovina test strips for glucose control are still in use. This paper includes an analysis of the costs of traditional monitoring and monitoring using biosensors. We also reviewed the monitoring of diabetes in neighboring countries such as Croatia, Slovenia, Montenegro, and Serbia in order to compare them with the current situation in Bosnia and Herzegovina.
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Appendices
Appendix 1
Country | Monitoring type | Monitoring with biosensors | Models and manufacturers of biosensors | Health Insurance Institute participation |
|---|---|---|---|---|
Bosnia and Herzegovina | SMBG | – | – | Health Insurance Institute provides strips for diabetes type 1 patients, while lancets are sold to the patients |
Montenegro | SMBG | – | – | Glucometer—insured diabetic patients on insulin therapy Diagnostic strips for device Diabetic children and adolescents till the age of 18 on insulin therapy, depending on number of prescribed daily dosages, get up to 200 strips Diabetic insured patients from the age 18 on insulin therapy, depending on number of prescribed daily dosages, get between 25 and 100 strips Lancets for blood sampling from the finger |
Croatia | SMBG and biosensors | In use since year 2018 | 1. FreeStyle Libre flash glucose monitoring system—reader and sensor (manufacturer Abbot) 2. Medtronic MiniMed MiniLink Real time transmitter, Medtronic MiniMed Guardia 2 link transmitter and Enlite sensor (manufacturer Medtronic MiniMed) | Children from the age 4 till the age 18 Pregnant patients Blind patients Diabetes type 1 patients on intense insulin therapy (4 or more daily dosages), with detected hypoglycemia in hospital care in Zagreb, Clinic Sestre Milosrdnice, Dubrava, University clinic for diabetes, endocrinology and metabolic diseases Vuk Vrhovac, Clinic in Split, Osijek and Rijeka |
Serbia | SMBG | – | – | Strips for children that use 4 or more daily dosages of insulin, also for pregnant patients—150 strips a month or 450 for 3 months For children on 2–3 insulin daily dosages—100 strips a month Children with diabetes type 2 that are not on insulin therapy—50 strips a month Adults on 1, 2 or 3 insulin daily dosages—50 strips for 3 months Adults on 4 or more insulin daily dosages—100 strips a month Blind and visually impaired patients with diabetes mellitus—device for glucose measurement with strips |
Slovenia | SMBG and biosensors | In use since year 2014 | Dexcom CGM | Children under 7 Pregnant patients Bad regulation of diabetes mellitus |
Appendix 2
Manufacturer | Name of biosensor | Mechanism | Main characteristics relevant for patients | Work memory | Special remarks | Price |
|---|---|---|---|---|---|---|
Bayer | Ascensia Elite | Enzymatic system that measures glucose in blood | Sound signal implies that procedure was done properly | 14 days 20 measurements | Additional ketones tracking Point of care testing | 40€ |
Elite XL | Enzymatic system that measures glucose in blood | 100 measurements | Self-testing | 120€ | ||
Esprit | Capillary blood glucose, referenced to whole blood | Sensory capillary technology provides the best accuracy Longlasting battery | 120 measurements | Laboratory testing Duration of test 30 s | 399€ | |
Esprit 2 | Capillary blood glucose, referenced to whole blood | |||||
Contour | Microfill sensors | New Fast Accurate, reliable | 240 measurements | 0.6 µl of sample | >399€ | |
Life scan | One Touch Fast Take | Electrochemical | Comfortable, fast | 15 s | Calibrated for whole blood | 87.2–261.5€ |
One Touch Profile | Electrochemical | Comfortable, simple, fast | 15 s | |||
One Touch Ultra | Electrochemical | Fast, with software, safe, accurate | 5 s | 1 µl of sample | ||
Rosche | TMAccu-Chek | Combination of sensor enzymatic strips Electrochemical | Fast, with software, safe, accurate | 100 measurements 15 s 2 steps | 1 µl of sample | 87.2€ |
Dexcom | Dexcom PLATINUM G4 i PLATINUM G5 | Glucose level measured by sensory needle | Modern, with software, fast, accurate, reliable, simple, discrete | 7 days | High precision for hypo/hyperglyce mia, used for diagnosis confirmation | 717.3–1534€ |
Integrity application | Glucotrack | Ultrasonic, electromagnetic, thermal technology based in work unit | Safe, reliable, painless, simple for use | 6 months | Unlimited testing as needed Offline analysis and USB port for data | 1743.1€ (work unit 104, 587€) |
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Hadžović, H. et al. (2020). Use of Biosensors in Diabetes Monitoring: Medical and Economic Aspects. In: Badnjevic, A., Škrbić, R., Gurbeta Pokvić, L. (eds) CMBEBIH 2019. CMBEBIH 2019. IFMBE Proceedings, vol 73. Springer, Cham. https://doi.org/10.1007/978-3-030-17971-7_113
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