Monash University, Melbourne, VIC.
Monash Health, Melbourne, VIC.
Med J Aust. 2021 Nov 15;215(10):473-478. doi: 10.5694/mja2.51118. Epub 2021 Jun 20.
Type 1 diabetes presents significant challenges for optimal management. Despite intensive glycaemic control being the standard of care for several decades, glycaemic targets are infrequently achieved and the burden of complications remains high. Therefore, the advancement of diabetes management technologies has a major role in reducing the clinical and economic impact of the disease on people living with type 1 diabetes and on health care systems. However, a national framework is needed to ensure equitable and sustainable implementation of these technologies as part of holistic care.
This consensus statement considers technologies for insulin delivery, glucose sensing and insulin dose advice that are commercially available in Australia. While international position statements have provided recommendations for technology implementation, the ADS/ADEA/APEG/ADIPS Working Group believes that focus needs to shift from strict trial-based glycaemic criteria towards engagement and individualised management goals that consider the broad spectrum of benefits offered by technologies.
This Australian consensus statement from peak national bodies for the management of diabetes across the lifespan outlines a national framework for the optimal implementation of technologies for people with type 1 diabetes. The Working Group highlights issues regarding equity of access to technologies and services, scope of clinical practice, credentialling and accreditation requirements, regulatory issues with "do-it-yourself" technology, national benchmarking, safety reporting, and ongoing patient advocacy.
1 型糖尿病的管理极具挑战性。尽管几十年来强化血糖控制一直是标准治疗方法,但血糖目标仍很少能达到,并发症负担仍然很高。因此,糖尿病管理技术的进步对于减轻 1 型糖尿病患者和医疗保健系统的疾病的临床和经济影响具有重要作用。然而,需要建立一个国家框架,以确保公平和可持续地实施这些技术,作为整体护理的一部分。
本共识声明考虑了在澳大利亚商业上可获得的胰岛素输送、血糖监测和胰岛素剂量建议技术。虽然国际立场声明已经为技术实施提供了建议,但 ADS/ADEA/APEG/ADIPS 工作组认为,重点需要从严格的基于试验的血糖标准转移到参与和个体化的管理目标,这些目标考虑到技术提供的广泛益处。
来自管理糖尿病跨生命周期的国家最高机构的这份澳大利亚共识声明概述了一个国家框架,用于优化 1 型糖尿病患者的技术实施。工作组强调了在技术和服务获取、临床实践范围、认证和认可要求、“自己动手”技术的监管问题、国家基准、安全报告以及持续的患者宣传方面的公平性问题。