Glucose monitoring technology could become the go-to management strategy in a few years. Here’s where we are and where we are going.
The latest continuous glucose monitors (CGMs) are more portable and powerful than first-generation models. They’re also easier to use and the science behind them is exponentially more accurate, says Michael LeMay, MD, an endocrinologist at Hartford Hospital in Hartford, Connecticut.
“I expect they’ll continue to get better,” he says.
CGMs, which constantly measure glucose levels for diabetic patients, may include special features such as:
• An alarm that can sound when an individual’s glucose level goes too low or high;
• The ability to record (based on user input) meals, physical activity, and medicines;
• The ability to show a person’s glucose levels without requiring a fingerstick;
The ability to download data to a computer or smart device so trends can be more easily read;The ability to immediately transport information to the smartphone of another, perhaps a parent, partner, or caregiver.
CGM Effects on Patient Care
Several studies have promising results regarding how patients can benefit when using CGMs.
According to a September 15, 2017 JDRF-funded study, of diabetic mothers, the use of a CGM during pregnancy results in healthier moms and babies. The study showed that using a CGM during and prior to pregnancy improves health outcomes, because women who used a CGM spent 100 extra minutes per day with blood sugars in a healthy range. That results in their babies being less likely to have hypoglycemia postpartum
Thirty-nine percent of patients with type 1 diabetes are using CGMs, yet healthcare providers see a steady upward trend in the adoption of the devices, according a survey of 339 patients and healthcare providers that appeared in Diabetes In Control in March 2018. In fact, providers who took the survey estimate that 77% of their patients will be using CGM five years from now.
Practitioners believe CGM usage in patients with type 2 diabetes will soar in the next five years. Currently, they estimate 11% of these patients are using CGMs; in five years, they expect that will increase to 46%.
Schafer Boeder, MD, division of endocrinology, at the University of California, San Diego, La Jolla, however, says that only about 15% to 20% of patients with type 1 diabetes-and a much smaller percentage of patients with type 2 diabetes-in the U.S., are believed to be using a CGM.
“Cost is a major barrier, though lack of familiarity by both patients and providers is also an issue,” Boeder says.
Although LeMay encourages patients to use the device, issues like insurance coverage prohibit some from doing so. “I’ll give a patient a sample sensor, which they get used to and love, but when they try to put in a prescription for it, they find it’s too expensive,” he says. “Sometimes, insurance companies lag behind.”
But the pipeline hasn’t been lagging. It includes high-tech CGM devices, such as smartphone-connected CGMs, wearable and smartphone-connected CGMs, and a “smart” diabetes management solution (also called an artificial/bionic pancreas), are expected to culminate in a higher adoption of CGMs among endocrinologists and patients.
The major innovation many people are waiting for-especially in the type 1 arena-is the fully closed-loop artificial pancreas, which requires a highly accurate and reliable CGM system, says Schaefer. Whether standalone, or as part of a closed-loop system, he expects CGM use among patients requiring multiple daily doses of insulin to increase steadily.
The FDA recently approved the Eversense Continuous Glucose Monitoring (CGM) system for patients 18 years or older. The device is the first FDA-approved CGM system to include a fully implantable sensor to detect glucose levels, which can be worn for up to 90 days. The sensor is implanted just under the skin during an outpatient procedure. In July, the company that developed the CGM reported that it expects it to ship in the next few weeks.
In the meantime, the use of CGM in the hospital setting-even for those not on CGM as outpatients-is an area of active research, Boeder says. If CGMs can reduce inpatient hypoglycemia events, decrease complications, shorten hospital stays, and/or reduce readmissions, it may become a standard technology in the hospital.
Chuck Green has covered healthcare for more than 10 years.