People with diabetes have to manage a lot of things to stay healthy — what they eat, when to exercise, dealing with stress, checking their glucose levels, and for many, taking medication or dosing insulin.…
People with diabetes have to manage a lot of things to stay healthy — what they eat, when to exercise, dealing with stress, checking their glucose levels, and for many, taking medication or dosing insulin. It’s a challenge, and I have great admiration for my patients who muster the grit, courage and determination every day to face that challenge.
But in addition to the care that health care professionals provide, one of the things that makes me thankful to be treating diabetes patients in this day and age is medical innovation. Over the past century, examples have ranged from the discovery of insulin to the development of personal blood glucose monitors, insulin pumps and an array of groundbreaking medications — all developments that help people with diabetes in their daily mission to keep their glucose in control, stay healthy and thrive.
One advance that has helped many people with diabetes make great progress in recent years and which has tremendous potential to help the nearly 7 million Americans that manage their diabetes with insulin is continuous glucose monitoring, or CGM.
Blood glucose meters display a reading from a fingerstick of where a person’s glucose level is at a single point in time. CGM systems, however, are worn on the body, measure glucose levels every few minutes and help the patient see not only where their glucose level is now, but where it has been, and most importantly, the rate and direction of where it is going in the near future.
Comprising a sensor that measures glucose in the interstitial fluid under the skin, a transmitter that relays the glucose data and a receiver that displays it, a CGM system provides valuable information that a person needs to make decisions that keep their glucose levels in check. Research confirms the value of CGM in its ability to improve long-term glucose control, to help patients increase the amount of time their glucose stays in a healthy range, and to reduce episodes of dangerously low glucose levels (hypoglycemia).
November is National Diabetes Month, and Nov. 14 is World Diabetes Day, times when the diabetes community reflects on where we’ve been and where we’re going. During these kinds of awareness occasions, it’s common to focus on the great challenges we face with diabetes management, including the rapid growth of diabetes around the world, the reality that most people with diabetes have faced out-of-control glucose levels and the fact that hypoglycemia is prevalent among insulin users.
Yet, considering the great need for people to better control their diabetes to prevent the dreaded long-term complications, combined with the research that supports the use of CGM among insulin users, it’s surprising that CGM is still underutilized among the millions who could benefit from it. Three out of 4 potential candidates for CGM don’t use it. Of those who try it, nearly one-third quit within a year, and many of those who continue don’t wear it as often as prescribed for a variety of reasons, many of which could be overcome with the application of a little human ingenuity. And that’s where medical innovation comes to our aid and why it’s so important.
As with many other diabetes technologies, innovation continues to make CGM more effective and easier for users. Here is an overview of some of the recent developments which warrant consideration from those considering trying CGM for the first time, or maybe trying it again:
Predictive alerts of impending high and low glucose: CGM makers have developed audible alerts and even transmitters that provide discreet on-body vibrating alerts. These signal to patients that their glucose levels are headed up or down in the near future, so they can take action to keep glucose in a safe and healthy range and to prevent dangerously low or high glucose levels.
Smartphone integration: While some CGM systems use their own proprietary handheld devices for a receiver, others have been developed with apps so that users’ smartphones can act as the receiving device that helps them view their glucose data.
Sharing of glucose data with a patient’s circle of care: Because smartphone integration is now part of some CGM systems, it’s possible for a patient to set up his or her CGM app so that it automatically shares personal glucose data with people designated by the patient, from healthcare professionals to family members and other caregivers.
Significantly longer sensor life: Changing out CGM sensors every seven to 14 days is a part of the CGM routine for users. But because of new technology, the life of sensors is increasing significantly. The Eversense Continuous Glucose Monitoring System, approved by the Food and Drug Administration, offers a small implantable sensor that lasts up to three months. It’s placed by a health care professional just beneath the skin in the upper arm in a simple in-office procedure.
Longer wear time of the CGM system: That same recently-approved system with the three-month sensor increases the length of time that users will wear a CGM system, and increased wear time is associated with improved glucose control. While users have been shown to wear CGM 50 to 78 percent of the time with earlier systems, the implantable sensor has contributed to patients now wearing it 92 to 93 percent of the time, demonstrating strong adherence to diabetes management as new and improved diabetes technology has become available.
Building blocks for the bionic pancreas: Thanks to advances in machine learning and artificial intelligence, clinically-tested dosing algorithms are making it possible for CGM systems to communicate with insulin pumps, which has paved the way to the development of automated insulin delivery and eventually to the autonomous bionic pancreas.
Continuous glucose monitoring is a medical advancement that has proven its clear value for diabetes management in terms of both convenience and clinical value for the patient. As it continues to evolve with innovations making it better and easier to use, more insulin-users who want to take a significant stride forward in controlling their glucose should give it serious consideration.