Continuous Glucose Monitoring in Insulin-Treated Type 2 Diabetes Mellitus in Sweden: A Scoping Review and Policy Landscape Analysis

Abstract

Background:

Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases in Sweden. Continuous glucose monitoring (CGM) is an increasingly important alternative to self-monitoring of blood glucose (SMBG), particularly for people receiving insulin.

Objectives:

To summarize the evidence for CGM in insulin-treated T2DM and conduct a policy landscape analysis of national and local guidelines to explore access to CGM in Sweden relative to other countries.

Methods:

A scoping review was conducted to identify evidence on the clinical, patient, and economic value of CGM, supplemented with searches of Swedish and European guidelines. Current recommendations for CGM in T2DM in Sweden were compared with European-wide and country-specific recommendations. Regional recommendations and funding processes within Sweden were reviewed to examine heterogeneity in local access to CGM.

Results:

Across international and Swedish studies, CGM was associated with improved clinical outcomes compared with SMBG, both for people with intensive insulin-treated T2DM and those on basal insulin only. The clinical benefits likely translate into fewer long-term diabetes complications and reduced resource utilization and budget impact versus SMBG. Health economic evaluations show that CGM can be considered a cost-effective intervention for all individuals treated with insulin in Sweden. European-wide guidance supports consideration of CGM for all insulin-treated individuals, but access in Sweden remains limited outside of the high-risk intensive insulin-treated population. This is exacerbated by regional heterogeneity in access, which partly stems from the attribution of budget responsibility to individual primary care units.

Conclusions:

The benefits associated with CGM show that an expansion of the Swedish recommendations to cover all insulin-treated people with T2DM is warranted. Persistent regional disparities must be addressed to ensure equitable access to care for people with T2DM in Sweden. The establishment of dedicated funding mechanisms within primary care should be considered to promote more equitable and sustainable access.

Graphical Abstract