LCQ6: Subsidising patients to purchase continuous glucose monitors
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Question:
It is learnt that a continuous glucose monitor (CGM) is a small sensor that can be inserted under the skin of the arm or abdomen to continuously measure the blood glucose level. Studies have found that using a CGM helps patients with Type 1 diabetes control their conditions and improve their quality of life, as well as reduce the incidence of serious diabetes-related complications. However, there are views pointing out that CGMs need to be replaced every two weeks, placing a considerable financial burden on low-income patient families. In this connection, will the Government inform this Council:
(1) as it has been reported that the Hong Kong Children's Hospital currently only provides a limited number of CGMs to young diabetes patients, while the "Jockey Club Support for Young People with Diabetes" funded by the Hong Kong Jockey Club only provides eligible diabetes patients between the ages of 2 and 30 with access to a two-year CGM supply, which fails to meet the long-term needs of the patients, whether the Government knows if the Hospital Authority (HA) will continuously provide young diabetes patients with a full year's supply of CGMs to cater for their needs; and
(2) whether it knows if HA will include CGMs in Privately Purchased Medical Items and, through the Samaritan Fund, provide subsidies to diabetes patients in financial need; if HA will, of the details; if not, the reasons for that?
Reply:
President,
Diabetes is one of the common chronic diseases in Hong Kong, with a prevalence of 8.5 per cent among persons aged 15-84 in Hong Kong as indicated in the Population Health Survey 2020-22. Diabetes is mainly classified into Type 1 and Type 2. Type 1 diabetes is caused by the dysfunction of insulin-producing cells, which may be related to hereditary factors, autoimmune disorders or some environmental factors. Type 2 diabetes is caused by the body's resistance to insulin. Apart from hereditary factors, key factors for developing Type 2 diabetes are associated with unhealthy lifestyle, including dietary patterns, obesity or lack of exercise.
The Hospital Authority (HA) provides diversified services to support various types of diabetic patients, including general out-patient services and specialist out-patient Diabetes Centre services. The general out-patient services serve patients with relatively stable conditions.
Meanwhile, the Diabetes Centres deliver comprehensive consultation and treatment services for patients with more complex conditions, overseen by a team of mainly endocrinologists and specialised diabetes nurses. The Centres provide patients with services including diabetes assessment, consultation, treatment, self-management education, metabolic risk assessment, so as to enable early detection of complications and facilitate appropriate management. Doctors will arrange various tests and treatment plans based on individual circumstances of patients.
In consultation with the HA, the consolidated reply to the question raised by Dr the Hon David Lam is as follows:
All diabetic patients require regular monitoring of their blood glucose levels. The traditional monitoring methods include blood tests and checking of blood glucose levels by home-use blood glucose meters. The continuous glucose monitoring system (CGM) mentioned in the question raised by Dr the Hon David Lam, which involves sensors inserted under the skin for measurement of blood glucose levels at all times and places, serves as a special monitoring tool for particular patients with clinical needs.
At present, the HA has guideline in place to provide CGM to individual patients with clinical needs for free in a timely manner, mainly for patients who need to monitor their blood glucose levels frequently so as to adjust their treatment plans, such as those requiring multiple daily insulin injections with unstable blood glucose levels, prone to hypoglycaemia, or suffering from hypoglycaemia unawareness. It includes Type 1 and Type 2 paediatric and adult diabetic patients. By collecting hundreds of glucose readings daily, CGM monitors blood glucose control parameters for these patients with specific clinical needs, including time-in-range, glucose variability and trend graphs. This assists the healthcare team in devising more appropriate treatment plans for patients. Additionally, CGM can improve glucose control and reduce the occurrence of hypoglycaemia in diabetic patients prone to hypoglycaemia or those suffering from hypoglycaemia unawareness.
Nonetheless, not all diabetic patients have the clinical need for CGM. Furthermore, since the CGM needs to be inserted under the skin and worn for extended periods, some patients may experience discomfort or unease, while skin allergies may even occur in some cases. As CGM measures glucose levels in interstitial fluid, the readings provided may slightly lag behind actual blood glucose level and have certain degree of discrepancy.
While providing appropriate treatment to patients, the HA must ensure that the limited public healthcare resources are utilised in a rational and optimal manner. In 2024, there were over 658 000 patients with diabetes receiving care from the HA. On this basis, providing CGM with a two-week service lifespan to all diabetic patients continuously for the whole year would not only cause information overload of blood glucose readings to healthcare personnel, but also entail an additional expenditure of several billion dollars per annum. As with the introduction of new drugs and devices, we have to take into account the cost-effectiveness and feasibility when determining the scope of use for individual monitoring devices.
The HA will continuously review the coverage of relevant services and technology development and, under the principle of optimising the utilisation of limited public resources, evaluate clinical services guidelines, including the use of different suitable testing methods to monitor the blood glucose levels of patients according to the clinical conditions and the actual needs of diabetic patients, so as to ensure the provision of suitable treatment to all patients with diabetes.
Thank you, President.
Ends/Wednesday, July 16, 2025
Issued at HKT 17:53
Issued at HKT 17:53
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