CGM technology advantages -
This is such a great tool to help the patients and the primary care physicians manage the disease. Richard M. Bergenstal, MD, executive director of the International Diabetes Center Park Nicollet and Health Partners in Minneapolis and an investigator in the MOBILE study, compared the effect of CGM to a diabetes drug.
You are using CGM to make your own drugs work to their best ability. As providers, we have been dancing around insulin — every article says the biggest barrier with insulin therapy is hypoglycemia. In another analysis, also published in JAMA in June, researchers assessed data from 41, adults with insulin-treated diabetes 5, with type 1; 36, with type 2 from to Mean HbA1c declined among real-time CGM initiators from 8.
Hypoglycemia rates declined among real-time CGM initiators from 5. In a study presented at the American Diabetes Association Scientific Sessions in June, researchers analyzed data from the French nationwide reimbursement claims database on 33, residents with type 1 diabetes and 40, with type 2 diabetes who used a flash glucose monitoring system between August and December Data included the number of daily glucose test strips individuals used before the study period and reimbursement for ICD codes for diabetic ketoacidosis from 1 year before to 1 year after first use of the FreeStyle Libre.
Additionally, decreases in DKA hospitalization rates were observed among those using multiple daily injections and those using an insulin pump. Yet the main barrier to analyzing CGM reports in the clinic is the ability to easily obtain them, according to Amy B. Criego, MD, MS, department chair in pediatric endocrinology at Park Nicollet Clinic and a medical director at the International Diabetes Center in Minneapolis.
To improve access, the International Diabetes Center partnered with Abbott on a pilot initiative beginning in spring to make FreeStyle Libre CGM data available at the point of care in select clinics.
The goal, Criego said, was for clinicians to place an order in the EHR for a patient with diabetes who agreed to share their CGM data. Data metrics would include time in the recommended glucose range and visual alerts for out-of-range values.
Currently, orders within the HealthPartners system clinics are available to directly integrate CGM data into the EHR once connection is established, Criego said. Tsimikas, whose institution adopted a remote patient monitoring program for CGM, said clinicians must be creative and consider new ways of facilitating engagement with this technology.
That is one way to integrate some virtual care to support both the primary care physician and the patient. And this tool can be accessed from anywhere. A formal study to evaluate that would be fascinating. Research conducted in the type 1 population, particularly among children, suggest race disparities persist in CGM uptake and continued use.
Data published in Diabetes Care in November showed white children are twice as likely to initiate and four times as likely to persist with CGM at 1 year compared with Black and Hispanic children, regardless of insurance type.
Similar data assessing CGM use among type 2 patients by race is scarce, though patterns are likely similar, Gavin said. Recent changes in Medicare rules may help widen access for people with type 2 diabetes. In September , CMS approved reimbursement for the FreeStyle Libre 2 Abbott , expanding access of the integrated CGM system, or iCGM, to Medicare beneficiaries with diabetes.
In July, a CMS policy change eliminated the four times per day testing requirement to qualify for a CGM device. The updated criteria went into effect July Gavin said diabetes stakeholders may also need to incorporate CGM into advocacy strategies with new approaches.
We must become more imaginative and supportive in the way we utilize technology, even if done on a trial basis to reach people in the most marginalized and vulnerable positions. We must be as creative in overcoming those gaps as we were intentional in generating those gaps. Researchers agree that payors want outcomes data that will justify the use of CGM by people with type 2 diabetes, lowering risks for both microvascular and macrovascular complications of diabetes.
Fewer hospitalizations? Less use of insulin? Less medications? Now that we showed a benefit, we need to show how this could reduce health care costs in other ways. In one of the first studies to assess risk for diabetes outcomes associated with time in range, published in Diabetes Care in , researchers assessed time in range among hospitalized patients with type 2 diabetes using masked CGM.
In a study published in Diabetes Care in , researchers evaluated associations of time in range with development or progression of retinopathy and microalbuminuria using the Diabetes Control and Complications Trial DCCT data set — calculating time in range from finger sticks — to validate use of the metric as an outcome measure.
In a retrospective, real-world study published in the Journal of the Endocrine Society in March, Bergenstal and colleagues analyzed IBM MarketScan Commercial Claims and Medicare Supplemental databases to assess the impact of flash CGM on diabetes-related events and hospitalizations among 2, people with type 2 diabetes prescribed short- or rapid-acting insulin therapy.
Outcomes were changes in acute diabetes-related events and all-cause inpatient hospitalizations, occurring during the first 6 months after acquiring the flash CGM system compared with event rates during the 6 months prior to CGM initiation.
At 6 months, acute diabetes-related event rates decreased from 0. All-cause inpatient hospitalizations rates decreased from 0. Bergenstal said the findings provide support for the use of flash CGM in type 2 diabetes patients treated with short- or rapid-acting insulin therapy to improve clinical outcomes and potentially reduce costs.
It is a challenge to demonstrate CGM is a benefit to them when the benefit is unequivocally long term. Payors want 7-year data with CGM in type 2. The only way I see that happening is if [drug] companies add CGM data to their CV outcomes trials.
If conducting a study with 10, participants and one drug for 6 years, assessing all of these adjudicated outcomes, and you threw in CGM twice a year, you would have your answer. In the meantime, Tsimikas said clinicians must do all they can to initiate CGM for any person with diabetes who is open to using it.
If you can get it to them early, you might prevent complications. Most patients will derive meaningful clinical benefits. The more you know, the more comfortable you are in clinical decision-making.
Seeing your blood glucose levels in real time can help you make more informed decisions about the food and beverages you consume, the physical activity you do, and the medicines you take. Keeping your blood glucose level in your target range can help prevent other health problems caused by diabetes.
A continuous glucose monitor CGM estimates what your glucose level is every few minutes and keeps track of it over time. A CGM has three parts. First, there is a tiny sensor that can be inserted under your skin, often the skin on your belly or arm, with a sticky patch that helps it stay there.
These sensors are called disposable sensors. Another type of CGM sensor—called an implantable sensor—may be placed inside your body. CGM sensors estimate the glucose level in the fluid between your cells, which is very similar to the glucose level in your blood. Sensors must be replaced at specific times, such as every few weeks, depending on the type of sensor you have.
The second part of the CGM is a transmitter. The transmitter sends the information, without using wires, to the third part, a software program that is stored on a smartphone, on an insulin pump , or on a separate device called a receiver.
Your doctor may recommend that you use a CGM if you need insulin to manage type 1 diabetes , type 2 diabetes , or another form of diabetes. Talk with your doctor about whether using a CGM could help you manage your diabetes. Doctors can prescribe CGMs for adults and children.
Some models can be used for children as young as 2 years old. Your doctor may suggest using a CGM all the time or only for a few days to help adjust your diabetes care. All CGMs estimate blood glucose levels, but they store and display the information in different ways.
Some CGMs send and display information to your smartphone or receiver automatically. But you will need to scan the CGM with a separate receiver or smartphone every few hours to view and store the data.
A third type of CGM collects data about your blood glucose level for your doctor to download and review later. Doctors provide this type of CGM to check on your diabetes care, and you wear it for a limited time.
For some CGM models, you may need to do a finger-stick test with a standard blood glucose monitor to calibrate the system and make sure the CGM readings are correct.
Many CGMs work with apps that have special features, such as. For safety, it is important to act quickly if a CGM alarm sounds when your glucose level is too low or too high. You should get help or follow your treatment plan to bring your glucose level into a healthy range. The CGM will create an alert and might display a graphic that shows whether your glucose level is rising or dropping—and how quickly—so you can choose the best way to reach your target range.
Over time, keeping your glucose levels in the healthy range can help you stay well and prevent diabetes complications. The people who benefit the most from a CGM are those who use it every day or nearly every day. Researchers are working to make CGMs more accurate and easier to use.
However, you may experience some issues while using a CGM. For safety, you may sometimes need to compare your CGM glucose readings with a finger-stick test and a standard blood glucose meter.
This could be needed if you doubt the accuracy of your CGM readings, if you are changing your insulin dose, or if your CGM gives a warning alert. You might have to replace parts of your CGM over time.
Disposable CGM sensors should be replaced every 7 to 14 days, depending on the model. Some implantable sensors can last up to days.
You may have to replace the transmitters of some CGMs. You may also need to reconnect the CGM, transmitter, and receiver or smartphone if your CGM is not working correctly.
Skin redness or irritation from the sticky patches used to attach the sensor may occur for some people. A CGM costs more than using a standard glucose meter, but it may be covered by your health insurance.
You might be able to get financial help for diabetes care from your health insurance or other resources. Check with your health insurance plan or Medicare to see if the costs will be covered. An artificial pancreas , also called an automated insulin delivery system AID , mimics how a healthy pancreas controls blood glucose in the body.
A CGM, an insulin pump, and a software program that shares information between the CGM and insulin pump make up the artificial pancreas.
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