Imagine a patient who needs to check his/her sugar 10-12 times a day. To do this, patient has to carry the testing supplies with them at school or at work. Patients have to prick themselves multiple times, log their readings and then make adjustments on their insulin doses based on the readings. For type I diabetes patients or complicated type 2 patients, controlling blood glucose becomes very challenging in most cases. Subtle variations in diet, physical activity or emotional stress can change blood sugars instantly. So, in these cases, if the blood sugar is not checked and insulin dose not adjusted, patients can suffer from the unknown sugar level. These spikes or lows in sugar can be harmful. Highs can lead to ketoacidosis, lows can lead to hypoglycemia-both are life threatening conditions. This is why, Continuos Glucose Monitoring can be life saving.
CGM devices are fully automatic devices which give patients and their caregivers, alerts about highs and lows, thereby patients can take appropriate action about what dosage of insulin should be administered or not administered. There are patients on insulin pumps which can be programmed and synced with CGM devices. This enables appropriate automatic delivery of insulin based on patient’s blood glucose. Caregivers can even monitor patient’s blood glucose remotely. For example, a parent can constantly monitor his/her child’s blood glucose on the cell phone app or receivers from work when the child is at school. Studies have proven that CGM has significantly helped improve blood glucose monitoring and achieved much better control on diabetes. Now patients do not have to carry testing kits at work or school and don’t have to deal with the pain from several pricks a day!
Study results published in the Annals of Internal Medicine show that continuous glucose monitoring (CGM) systems can help patients with Type 2 diabetes better control their BGLs.
After 24 weeks, Type 2 patients on multiple daily insulin injection therapy (MDI) who used the study’s CGM system lowered their average HbA1C levels from 8.5 percent to 7.7 percent. Patients with higher HbA1C baselines saw even more pronounced reductions — those with an A1C of 9.0 percent or higher saw an average 1.4 percent decrease. Meanwhile, the control group, which used fingerprick tests and a standard BGM, saw their average A1C levels decrease from 8.5 percent to 8 percent. While the gain from using a CGM may seem modest, it’s actually statistically significant.
“This arm of the DIaMonD study is one of the first to examine how well CGM works for people with Type 2 diabetes on MDI,” said Kevin Sayer, president and CEO of Dexcom, in a statement. “We are pleased to see a significant A1C reduction in this study, showing that the millions of people globally with Type 2 diabetes on MDI insulin therapy can benefit from CGM use.”
According to the study results, the A1C reductions occurred with minimal change in insulin dosages or dosing regime. Furthermore, CGM users also reported decreased time in hyperglycemia and increased time in their target blood sugar range compared to the control group.
Traditionally CGMs have been used with those with Type 1, but that trend may be shifting. In the study, CGM users reported high levels of satisfaction with the system. By the end of the study, 93 percent of the users were still regularly using the device, and they rated the benefits of the technology high and the hassles low.
Historically the approach is to give those with Type 2 an insulin and treatment regime until it begins to fail before adding more medication. Monitoring, in theory, would allow patients with Type 2 to have immediate feedback on their bodies and potentially avoid adding more medication.
Study participants ranged from 35 to 79 years old, with a mean age of 60. The study used the Dexcom G4® PLATINUM CGM System, which employs the same software as the current Dexcom G5® Mobile CGM System approved by the FDA for standalone use in insulin dosing.
Most insurances are covering CGM devices like Dexcom with a prior authorization from doctors. Some still don’t cover it because its not on their formularies. Some have it in their formulary but their criteria are very strict. These insurances require the patients to be type 1 only even though they have uncontrolled type 2 diabetes and are on intensive insulin regimen. Freestyle Libre system is also a good option for people who cannot afford Dexcom or Medtronic. Some DME pharmacies can also help these patients with their ability to bill medical plans.
Bottomline: If you have uncontrolled type 1 or type 2 diabetes, talk to you doctor about a CGM device. Your pharmacist can help you get it at at your pharmacy and train you on how to use it. Technology has also helped mankind and this is no different. As you read earlier, there are numerous studies that have shown CGM to be an effective tool to control diabetes.