What Is Cgm In Diabetes?

What Is Cgm In Diabetes
What is an artificial pancreas? – A CGM is one part of the “artificial pancreas” systems that are beginning to reach people with diabetes. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has played an important role in developing artificial pancreas technology.

An artificial pancreas replaces manual blood glucose testing and the use of insulin shots. A single system monitors blood glucose levels around the clock and provides insulin or both insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.

In 2016, the U.S. Food and Drug Administration approved a type of artificial pancreas system called a hybrid closed-loop system, This system tests your glucose level every 5 minutes throughout the day and night through a CGM, and automatically gives you the right amount of basal insulin, a long-acting insulin, through a separate insulin pump.

  • You will still need to test your blood with a glucose meter a few times a day.
  • And you’ll manually adjust the amount of insulin the pump delivers at mealtimes and when you need a correction dose.
  • The hybrid closed-loop system may free you from some of the daily tasks needed to keep your blood glucose stable—or help you sleep through the night without the need to wake and test your glucose or take medicine.

Talk with your health care provider about whether this system might be right for you. The NIDDK has funded – and continues to fund – several important studies on different types of artificial pancreas devices to better help people with type 1 diabetes manage their disease.

What is normal CGM?

Based on the data of healthy individuals wearing CGM, it appears that it is safe and healthy to strive for a fasting glucose between 72-85 mg/dL, a post-meal glucose level of 110 mg/dL or lower, and an average glucose of 100 mg/dL or lower.

Can you have a CGM without an insulin pump?

CGM therapy can be used with or without an insulin pump.

Can you get a CGM If you’re not on insulin?

Glucose Levels & Fasting Plasma Glucose (FPG) Test – The fasting plasma glucose (FPG) test measures the concentration of glucose in your blood when you haven’t consumed anything (except for water) for about 12 hours, and is typically the first test that a physician will prescribe if they suspect you might have diabetes.

It consists of getting your blood drawn after fasting for at least eight hours. Test results give physicians a clear view of your fasting glucose, but a lab-drawn test is only one data point. Alternatively, you can see your fasting glucose in an app like Signos. Even non-diabetics can get access to a continuous glucose monitor (CGM) through a Signos membership.

The CGM measures the glucose in your interstitial fluid and sends this information via bluetooth to the Signos app, where you can see a line graph of your glucose data. If you want to begin tracking your glucose levels, this is where you may wish to start.

  • Healthy glucose levels are often associated with healthier weight, better energy levels, and better cognitive skills.
  • On the other hand, abnormally high glucose levels can make it difficult for someone to lose weight and may indicate a complication with glucose regulation.
  • According to the World Health Organization (WHO) 1, average fasting blood glucose concentration ranges ought to waver between 70 mg/dL (3.9 mmol/L) and 100 mg/dL (5.6 mmol/L).

When fasting blood glucose levels are between 100 to 125 mg/dL (5.6 to 6.9 mmol/L), the WHO recommends changes in lifestyle and monitoring. If your fasting blood glucose is 126 mg/dL (7 mmol/L) or higher on two separate tests, your physician could diagnose you with diabetes and implement a treatment plan.

What are the disadvantages of CGM?

Caregivers reported three main drawbacks regarding CGM use: cost, concerns with accuracy & reliability, and insertion, adhesion, and removal difficulties.

Can you feel CGM?

Discomfort: – After initial application, it is normal to feel some sensations while getting used to the sensor on your arm, but if the discomfort persists for at least a few hours after applying the CGM, we’d recommend, Tips for avoiding discomfort when applying a sensor:

The best location to apply your sensor is in the fatty part of the back of your upper arm, in the river between tricep and deltoid and discomfort is more common when the sensor is over the triceps muscle. Avoid placing the sensor directly over your muscle as this has been associated with pain and discomfort.

Can a CGM help you lose weight?

Does lowering blood sugar help increase weight loss? – When blood sugar (or glucose) is high, your pancreas is triggered to produce more insulin to move that sugar out of your blood and into your cells. That’s a problem for weight loss, because your body only burns fat when it senses insulin levels dropping.

  1. Supplied with too much sugar and too much insulin, your body stores that sugar as fat that never gets burned.
  2. So while you might think you’re humming along just fine, your body may be in a chronic state of insulin production because of your chronically high blood sugar levels.
  3. This makes weight loss really hard to achieve.

Stable blood sugar, on the other hand, means your cells don’t get flooded with insulin, which in turn gives your body time to burn fat for energy in between meals. The result: weight loss. If you want to use a CGM to drop pounds, take a look at how your blood sugar levels respond to different foods.

Can I buy a CGM over the counter?

Do you need a prescription for a CGM? – To get a continuous glucose monitor from your pharmacy, you will need a prescription due to FDA regulations. However, you may be able to purchase a CGM from a 3rd party medical supplier, but the cost will be much higher since it will not be covered by insurance. Post Views: 1,330

Can a Type 2 diabetic get a CGM?

Mar 31, 2019 Evidence-Based Diabetes Management March 2019 Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.

  1. PRECIS: Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.
  2. A convergence of several healthcare megatrends will lead to increasingly common use of CGM in people with T2D and even those with prediabetes: (1) improvements in CGM accuracy, size, and cost; (2) the ability to upload data to the cloud; (3) the availability of digital coaching tools and analytic software, and soon, artificial intelligence, and (4) a shift toward value-based care.

In 2019, estimates put more than 30 million Americans living with T2D and 84 million with prediabetes, and both numbers are rising. Direct US healthcare spending on diabetes, both type 1 diabetes (T1D) and T2D, is currently estimated at $237 billion, with 1 in 4 US healthcare dollars going toward the care of people with diabetes.1 The critical importance of early glycemic control to prevent acute complications and halt disease progression to prevent chronic complications only intensifies as these costs, including the rising costs of insulin, increase.

SMBG and A1C Are Inadequate The ability for patients and providers to gauge glycemic control in T2D depends on tools that provide incomplete information: self-monitoring of blood glucose (SMBG) data and glycated hemoglobin (A1C). It is challenging to get more than a limited set of SMBG data due to the inconvenience and pain associated with fingersticks, cost of test strips, and unforgiving requirements for specific timing.

Even in the best of circumstances, SMBG data can be challenging to interpret. Patients and providers must frequently extrapolate from a single fasting blood glucose (BG) value or from glucose values at scattershot time points without clear temporal relationships to the food, exercise, or other stressors that provide key context.

It should come as no surprise that although SMBG remains commonly used in both insulin-treated and noninsulin-treated patients, study results in noninsulin-treated patients have struggled to show efficacy of SMBG in changing patient behavior or reducing A1C.2 While A1C provides a useful measure of overall control, it cannot, either in real time or retrospectively, reveal a person’s specific behaviors and actions to more meaningfully inform patient and provider decisions.

An A1C of 7% may underlie either exquisitely stable BG values or mask a roller coaster, coupling dramatic postprandial BG spikes with overly aggressive insulin use and resultant hypoglycemia. Cheaper and Better CGMs The first CGM was released by MiniMed (now Medtronic) in 1999.

  • These early systems were rarely used due to cost, painful insertion, bulky size, poor accuracy, and the requirement for numerous fingerstick calibrations.
  • However, as the technology has improved, data have shown improved glycemic control and decreased rates of hypoglycemia in those using CGM, leading both the Endocrine Society and American Diabetes Association to state that CGM use represents standard of care in T1D.3,4 CGM in Americans with T1D is now on an exponential growth curve, rising from 6% in 2011 to 12% in 2014 to 24% in 2016 to 38% in 2018.5 High costs and uncertainty over efficacy and necessity have kept CGM from widespread use in people with T2D.

However, the newest CGM models, the Abbott Freestyle Libre and Dexcom G6, have begun to overcome many of these technical barriers to use of CGM systems. The sensors are inserted painlessly, are small enough to fit easily under clothing, can remain in place for 10 to 14 days, and are FDA approved as sufficiently accurate to use in lieu of fingersticks to make insulin-dosing decisions.

  1. Overcoming another significant barrier to use, data can now be seamlessly and continuously uploaded wirelessly to the cloud via a user’s smartphone.
  2. Of note, the Libre is a flash glucose monitor, requiring the user to scan the sensor to reveal glucose information and recent trends.
  3. Although it cannot alert a person to acute hyperglycemia or hypoglycemia in the middle of the night, this is a nonessential feature for the majority of people with T2D.
See also:  Buah Yang Mencegah Penyakit Jantung Kanker Diabetes Adalah?

Perhaps most importantly, Abbott has introduced a new, lower-pricing category with Libre, at around $75 to $150 each month for sensors (2 sensors that last 14 days each), translating to $900 to $1800 per year compared with what is typically $3000 to $5000 per year for traditional CGM.

Real-time Biofeedback Enables Behavior Change CGM affords 2 major benefits over the current standard of SMBG coupled with A1C testing: first, a vast increase in the quantity of blood glucose information, which provides a more comprehensive view of glycemic control. Rather than snapshots in time, continuous information allows us to capture important metrics like time in range, time in hypoglycemia, glucose variability, and many other emerging “glycometrics.” These additional metrics cannot be captured with SMBG, even in the most diligent patients.

A CGM recording BG every 5 minutes will record 105,120 BG readings per year compared with between just 1000 to 2000 in a person doing frequent SMBG. Second is the ability of CGM systems to provide real-time biofeedback. With real-time data now seamlessly available on a user’s mobile device and the internet, easily visible trends and trajectories can help a person understand their own glycemic response in a more meaningful way.

  • Patients can observe which foods and exercises affect them the most.
  • Iterative exposure to this immediate biofeedback allows patients to learn about their own bodies and physiologic responses.
  • For example, we recently saw a 70-year-old man with T2D and heart disease, with an A1C of 7.5%, who takes metformin but had resisted making any changes to his diet.

When he saw his graph of Libre data ( Figure 1 ), he immediately identified the daily morning spike in his glucose level and its source: his daily glass of orange juice and banana. He cut these from his diet and reported an immediate improvement in his glucose levels.

Also noteworthy is that had he used traditional fingersticks, he would have been completely unaware of these significant glucose spikes. His postbreakfast CGM scans showed readings of 81, 114, 131, and 99 mg/dL ( Figure 2 ). Clinical study results demonstrate that CGM in T2D is powerful for behavior change, a critical pillar in management.

Patients adhere to exercise recommendations more consistently 6,7 and decrease their caloric intake when using CGM systems.7 In addition, patients with T2D using CGMs have less hypoglycemia 8 and, importantly, they have A1C reduction without intensification of their existing treatments.9 New Opportunities for Data Analysis and Coaching Another challenge to date has been the lack of delivery system capacity to review, analyze, and interpret data, and then coach people with T2D based on their day-to-day glucose levels, a constraint which could potentially be magnified with the increased data provided by CGM.

  1. However, tech-enabled digital coaching services are emerging to help provide on-demand, accessible support for people with diabetes and prediabetes.
  2. Companies like Omada Health, Canary Health, Lark Health, Livongo, and others provide multiple touch points with enrolled patients to use biometric data (eg weight, blood pressure, blood glucose) for coaching and behavior change.

Several of these services are already certified by CMS to provide digital diabetes prevention programs (DPP), and the availability of cheaper CGM means they will soon have access to rich, continuous BG data to be able to guide patients in interpreting and acting upon them.

  1. This will soon enable a capacity and scale for diabetes coaching that has never before been possible using the traditional care delivery system.
  2. The emergence of artificial intelligence tools to aid in data interpretation and even to automate some of the coaching via “chatbot” will only make this more efficient and cheaper.

Cost Implications of CGM Use in Type 2 Diabetes One study looked at long-term cost-effectiveness for CGM use in people with T2D based on A1C reduction, projecting decreased rates of diabetes associated complications.10 Although we anticipate that A1C reduction through lifestyle changes by CGM users could prevent the addition of costly new medications or dose intensification of existing treatments, more study is needed to test this.

This matters: Studies looking at A1C compared with healthcare costs have found significant impacts.11,12 In one case, a 1% or more decrease in A1C was associated with $685 to $950 per year lower total healthcare costs, 13 and in another, a 1% increase in A1C was associated with a 7% increase in healthcare costs over the next 3 years.14 There are likely to be cost savings for people switching from frequent SMBG to CGM.

Given that a person using 4 test strips a day at a cost of $1.30 per test strip—costs can vary widely from $0.10 to $2.00—is consuming $156 per month in test strips, not to mention other consumables like lancets, the direct cost of CGM might actually be lower in this population in some cases, assuming these patients can largely eliminate their use of test strips.

For those using much less frequent SMBG today, such as those not on insulin or with prediabetes, the incremental costs of CGM may seem imposing—but this doesn’t need to be the case. If one were to use a Libre for only 14 days every 3 months, the cost of sensors would be $300 per year, at most, equivalent to about 4 to 5 test strips per week (at $1.30 per strip), and we would argue the CGM would be of substantially higher value.

Periodic CGM use enables treatment regimen changes, but more importantly, as seen by Vigersky et al, observations people make and behaviors they change while using CGM result in lower blood glucose levels even after they have stopped using CGM.15 We believe that intermittent CGM use paired with coaching will provide much more impetus for lifestyle change than the current standard of every-3-months A1C with sporadic SMBG.

  • Summary With rapidly improving CGM technology, wireless data upload, lower-cost CGM devices, and the availability of digital coaching tools, we believe the time is ripe for CGM use in a much broader population, including those with T2D who are on oral medications and those with prediabetes.
  • Although additional studies will need to be done to demonstrate benefit in these populations, costs will likely continue to fall and technology will continue to improve, only further strengthening the value proposition for wider CGM use.

AUTHOR INFORMATION: Division of Endocrinology, University of California, San Francisco (TK, AN); UCSF Center for Digital Health Innovation (AN). CORRESPONDING AUTHOR: Aaron Neinstein, MD University of California, San Francisco 1700 Owens Street, Suite 541 San Francisco, CA 94158 [email protected] 415-476-5397 FUNDING: There are no relevant funding sources.

  1. DISCLOSURES: Dr Neinstein has received research support from Cisco Systems Inc.
  2. And The Commonwealth Fund.
  3. He has been a consultant to Steady Health, Nokia Growth Partners, WebMD, and Grand Rounds and has received speaking honoraria from Academy Health and Symposia Medicus.
  4. He is an uncompensated medical adviser for Tidepool.

Dr Kompala has no disclosures.REFERENCES:

American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care.2018;41(5):917-928. doi: doi.org/10.2337/dci18-0007. Malanda UL, Welschen LMC, Riphagen II, Dekker JM, Nijpels G, Bot SDM. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev.2012;1:CD005060. doi: 10.1002/14651858.CD005060.pub3. Peters AL, Ahmann AJ, Battelino T, et al. Diabetes technology-continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.2016;101(11):3922-3937. doi: 10.1210/jc.2016-2534. American Diabetes Association. Chapter 7: diabetes technology: standards of medical care in diabetes-2019. Diabetes Care.2019;42(suppl 1):S71-S80. doi: 10.2337/dc19-S007. Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther.2019;21(2):66-72. doi: 10.1089/dia.2018.0384. Allen NA, Fain JA, Braun B, Chipkin SR. Continuous glucose monitoring in non-insulin-using individuals with type 2 diabetes: acceptability, feasibility, and teaching opportunities. Diabetes Technol Ther.2009;11(3):151-158. doi: 10.1089/dia.2008.0053. Taylor PJ, Thompson CH, Brinkworth GD. Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: a narrative review. J Diabetes Investig.2018;9(4):713-725. doi: 10.1111/jdi.12807. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther.2017;8(1):55-73. doi: 10.1007/s13300-016-0223-6. Park C, Le QA. The effectiveness of continuous glucose monitoring in patients with type 2 diabetes: a systematic review of literature and meta-analysis. Diabetes Technol Ther.2018;20(9):613-621. doi: 10.1089/dia.2018.0177. Fonda SJ, Graham C, Munakata J, Powers JM, Price D, Vigersky RA. The cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) in type 2 diabetes. J Diabetes Sci Technol.2016;10(4):898-904. doi: 10.1177/1932296816628547. Fitch K, Pyenson BS, Iwasaki K. Medical claim cost impact of improved diabetes control for Medicare and commercially insured patients with type 2 diabetes. J Manag Care Pharm.2013;19(8):609-620, 620a-620-d. doi: 10.18553/jmcp.2013.19.8.609. Juarez D, Goo R, Tokumaru S, Sentell T, Davis J, Mau M. Association between sustained glycated hemoglobin control and healthcare costs.2013;5(2):59-64. Wagner EH. Effect of improved glycemic control on health care costs and utilization. JAMA.2001;285(2):182-189. doi: 10.1001/jama.285.2.182. Gilmer TP, O’Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care.1997;20(12):1847-1853. Vigersky RA, Fonda SJ, Chellappa M, Walker MS, Ehrhardt NM. Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes. Diabetes Care.2012;35(1):32-38. doi: 10.2337/dc11-1438.

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How expensive is levels CGM?

What’s the cost? – When you first sign up for Levels, the total cost will be $398 USD plus tax. This includes:

  1. The first month of continuous glucose monitors (w/ either two 14-day or three 10-day CGMs) at $199 + tax,
  2. The Annual Membership fee of $199 + tax.

When you sign up for a Levels Annual Membership and complete the month-long program, you can choose to continue with an ongoing subscription of CGM shipments (i.e. monthly, every other month, quarterly shipments) throughout the course of your annual membership at $199 per shipment.

Which CGM is the cheapest?

What is the cheapest CGM? – The least expensive CGM without insurance by far is the FreeStyle Libre products. In the U.S. right now, you can get the Libre2 or 14-day system. At $75/month, you could say that you can’t afford NOT to use one. Compare that to the cost of chronic disease, it’s a great deal.

Does type 2 diabetes qualify CGM?

Mar 31, 2019 Evidence-Based Diabetes Management March 2019 Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.

  • PRECIS: Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.
  • A convergence of several healthcare megatrends will lead to increasingly common use of CGM in people with T2D and even those with prediabetes: (1) improvements in CGM accuracy, size, and cost; (2) the ability to upload data to the cloud; (3) the availability of digital coaching tools and analytic software, and soon, artificial intelligence, and (4) a shift toward value-based care.

In 2019, estimates put more than 30 million Americans living with T2D and 84 million with prediabetes, and both numbers are rising. Direct US healthcare spending on diabetes, both type 1 diabetes (T1D) and T2D, is currently estimated at $237 billion, with 1 in 4 US healthcare dollars going toward the care of people with diabetes.1 The critical importance of early glycemic control to prevent acute complications and halt disease progression to prevent chronic complications only intensifies as these costs, including the rising costs of insulin, increase.

  • SMBG and A1C Are Inadequate The ability for patients and providers to gauge glycemic control in T2D depends on tools that provide incomplete information: self-monitoring of blood glucose (SMBG) data and glycated hemoglobin (A1C).
  • It is challenging to get more than a limited set of SMBG data due to the inconvenience and pain associated with fingersticks, cost of test strips, and unforgiving requirements for specific timing.

Even in the best of circumstances, SMBG data can be challenging to interpret. Patients and providers must frequently extrapolate from a single fasting blood glucose (BG) value or from glucose values at scattershot time points without clear temporal relationships to the food, exercise, or other stressors that provide key context.

It should come as no surprise that although SMBG remains commonly used in both insulin-treated and noninsulin-treated patients, study results in noninsulin-treated patients have struggled to show efficacy of SMBG in changing patient behavior or reducing A1C.2 While A1C provides a useful measure of overall control, it cannot, either in real time or retrospectively, reveal a person’s specific behaviors and actions to more meaningfully inform patient and provider decisions.

An A1C of 7% may underlie either exquisitely stable BG values or mask a roller coaster, coupling dramatic postprandial BG spikes with overly aggressive insulin use and resultant hypoglycemia. Cheaper and Better CGMs The first CGM was released by MiniMed (now Medtronic) in 1999.

  • These early systems were rarely used due to cost, painful insertion, bulky size, poor accuracy, and the requirement for numerous fingerstick calibrations.
  • However, as the technology has improved, data have shown improved glycemic control and decreased rates of hypoglycemia in those using CGM, leading both the Endocrine Society and American Diabetes Association to state that CGM use represents standard of care in T1D.3,4 CGM in Americans with T1D is now on an exponential growth curve, rising from 6% in 2011 to 12% in 2014 to 24% in 2016 to 38% in 2018.5 High costs and uncertainty over efficacy and necessity have kept CGM from widespread use in people with T2D.

However, the newest CGM models, the Abbott Freestyle Libre and Dexcom G6, have begun to overcome many of these technical barriers to use of CGM systems. The sensors are inserted painlessly, are small enough to fit easily under clothing, can remain in place for 10 to 14 days, and are FDA approved as sufficiently accurate to use in lieu of fingersticks to make insulin-dosing decisions.

Overcoming another significant barrier to use, data can now be seamlessly and continuously uploaded wirelessly to the cloud via a user’s smartphone. Of note, the Libre is a flash glucose monitor, requiring the user to scan the sensor to reveal glucose information and recent trends. Although it cannot alert a person to acute hyperglycemia or hypoglycemia in the middle of the night, this is a nonessential feature for the majority of people with T2D.

Perhaps most importantly, Abbott has introduced a new, lower-pricing category with Libre, at around $75 to $150 each month for sensors (2 sensors that last 14 days each), translating to $900 to $1800 per year compared with what is typically $3000 to $5000 per year for traditional CGM.

Real-time Biofeedback Enables Behavior Change CGM affords 2 major benefits over the current standard of SMBG coupled with A1C testing: first, a vast increase in the quantity of blood glucose information, which provides a more comprehensive view of glycemic control. Rather than snapshots in time, continuous information allows us to capture important metrics like time in range, time in hypoglycemia, glucose variability, and many other emerging “glycometrics.” These additional metrics cannot be captured with SMBG, even in the most diligent patients.

A CGM recording BG every 5 minutes will record 105,120 BG readings per year compared with between just 1000 to 2000 in a person doing frequent SMBG. Second is the ability of CGM systems to provide real-time biofeedback. With real-time data now seamlessly available on a user’s mobile device and the internet, easily visible trends and trajectories can help a person understand their own glycemic response in a more meaningful way.

  1. Patients can observe which foods and exercises affect them the most.
  2. Iterative exposure to this immediate biofeedback allows patients to learn about their own bodies and physiologic responses.
  3. For example, we recently saw a 70-year-old man with T2D and heart disease, with an A1C of 7.5%, who takes metformin but had resisted making any changes to his diet.

When he saw his graph of Libre data ( Figure 1 ), he immediately identified the daily morning spike in his glucose level and its source: his daily glass of orange juice and banana. He cut these from his diet and reported an immediate improvement in his glucose levels.

Also noteworthy is that had he used traditional fingersticks, he would have been completely unaware of these significant glucose spikes. His postbreakfast CGM scans showed readings of 81, 114, 131, and 99 mg/dL ( Figure 2 ). Clinical study results demonstrate that CGM in T2D is powerful for behavior change, a critical pillar in management.

Patients adhere to exercise recommendations more consistently 6,7 and decrease their caloric intake when using CGM systems.7 In addition, patients with T2D using CGMs have less hypoglycemia 8 and, importantly, they have A1C reduction without intensification of their existing treatments.9 New Opportunities for Data Analysis and Coaching Another challenge to date has been the lack of delivery system capacity to review, analyze, and interpret data, and then coach people with T2D based on their day-to-day glucose levels, a constraint which could potentially be magnified with the increased data provided by CGM.

  1. However, tech-enabled digital coaching services are emerging to help provide on-demand, accessible support for people with diabetes and prediabetes.
  2. Companies like Omada Health, Canary Health, Lark Health, Livongo, and others provide multiple touch points with enrolled patients to use biometric data (eg weight, blood pressure, blood glucose) for coaching and behavior change.

Several of these services are already certified by CMS to provide digital diabetes prevention programs (DPP), and the availability of cheaper CGM means they will soon have access to rich, continuous BG data to be able to guide patients in interpreting and acting upon them.

  • This will soon enable a capacity and scale for diabetes coaching that has never before been possible using the traditional care delivery system.
  • The emergence of artificial intelligence tools to aid in data interpretation and even to automate some of the coaching via “chatbot” will only make this more efficient and cheaper.

Cost Implications of CGM Use in Type 2 Diabetes One study looked at long-term cost-effectiveness for CGM use in people with T2D based on A1C reduction, projecting decreased rates of diabetes associated complications.10 Although we anticipate that A1C reduction through lifestyle changes by CGM users could prevent the addition of costly new medications or dose intensification of existing treatments, more study is needed to test this.

This matters: Studies looking at A1C compared with healthcare costs have found significant impacts.11,12 In one case, a 1% or more decrease in A1C was associated with $685 to $950 per year lower total healthcare costs, 13 and in another, a 1% increase in A1C was associated with a 7% increase in healthcare costs over the next 3 years.14 There are likely to be cost savings for people switching from frequent SMBG to CGM.

See also:  Mengapa Terjadi Proses Glukoneogenesis Pada Penderita Diabetes?

Given that a person using 4 test strips a day at a cost of $1.30 per test strip—costs can vary widely from $0.10 to $2.00—is consuming $156 per month in test strips, not to mention other consumables like lancets, the direct cost of CGM might actually be lower in this population in some cases, assuming these patients can largely eliminate their use of test strips.

  1. For those using much less frequent SMBG today, such as those not on insulin or with prediabetes, the incremental costs of CGM may seem imposing—but this doesn’t need to be the case.
  2. If one were to use a Libre for only 14 days every 3 months, the cost of sensors would be $300 per year, at most, equivalent to about 4 to 5 test strips per week (at $1.30 per strip), and we would argue the CGM would be of substantially higher value.

Periodic CGM use enables treatment regimen changes, but more importantly, as seen by Vigersky et al, observations people make and behaviors they change while using CGM result in lower blood glucose levels even after they have stopped using CGM.15 We believe that intermittent CGM use paired with coaching will provide much more impetus for lifestyle change than the current standard of every-3-months A1C with sporadic SMBG.

  • Summary With rapidly improving CGM technology, wireless data upload, lower-cost CGM devices, and the availability of digital coaching tools, we believe the time is ripe for CGM use in a much broader population, including those with T2D who are on oral medications and those with prediabetes.
  • Although additional studies will need to be done to demonstrate benefit in these populations, costs will likely continue to fall and technology will continue to improve, only further strengthening the value proposition for wider CGM use.

AUTHOR INFORMATION: Division of Endocrinology, University of California, San Francisco (TK, AN); UCSF Center for Digital Health Innovation (AN). CORRESPONDING AUTHOR: Aaron Neinstein, MD University of California, San Francisco 1700 Owens Street, Suite 541 San Francisco, CA 94158 [email protected] 415-476-5397 FUNDING: There are no relevant funding sources.

  • DISCLOSURES: Dr Neinstein has received research support from Cisco Systems Inc.
  • And The Commonwealth Fund.
  • He has been a consultant to Steady Health, Nokia Growth Partners, WebMD, and Grand Rounds and has received speaking honoraria from Academy Health and Symposia Medicus.
  • He is an uncompensated medical adviser for Tidepool.

Dr Kompala has no disclosures.REFERENCES:

American Diabetes Association. Economic costs of diabetes in the US in 2017. Diabetes Care.2018;41(5):917-928. doi: doi.org/10.2337/dci18-0007. Malanda UL, Welschen LMC, Riphagen II, Dekker JM, Nijpels G, Bot SDM. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev.2012;1:CD005060. doi: 10.1002/14651858.CD005060.pub3. Peters AL, Ahmann AJ, Battelino T, et al. Diabetes technology-continuous subcutaneous insulin infusion therapy and continuous glucose monitoring in adults: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab.2016;101(11):3922-3937. doi: 10.1210/jc.2016-2534. American Diabetes Association. Chapter 7: diabetes technology: standards of medical care in diabetes-2019. Diabetes Care.2019;42(suppl 1):S71-S80. doi: 10.2337/dc19-S007. Foster NC, Beck RW, Miller KM, et al. State of type 1 diabetes management and outcomes from the T1D exchange in 2016-2018. Diabetes Technol Ther.2019;21(2):66-72. doi: 10.1089/dia.2018.0384. Allen NA, Fain JA, Braun B, Chipkin SR. Continuous glucose monitoring in non-insulin-using individuals with type 2 diabetes: acceptability, feasibility, and teaching opportunities. Diabetes Technol Ther.2009;11(3):151-158. doi: 10.1089/dia.2008.0053. Taylor PJ, Thompson CH, Brinkworth GD. Effectiveness and acceptability of continuous glucose monitoring for type 2 diabetes management: a narrative review. J Diabetes Investig.2018;9(4):713-725. doi: 10.1111/jdi.12807. Haak T, Hanaire H, Ajjan R, Hermanns N, Riveline J-P, Rayman G. Flash glucose-sensing technology as a replacement for blood glucose monitoring for the management of insulin-treated type 2 diabetes: a multicenter, open-label randomized controlled trial. Diabetes Ther.2017;8(1):55-73. doi: 10.1007/s13300-016-0223-6. Park C, Le QA. The effectiveness of continuous glucose monitoring in patients with type 2 diabetes: a systematic review of literature and meta-analysis. Diabetes Technol Ther.2018;20(9):613-621. doi: 10.1089/dia.2018.0177. Fonda SJ, Graham C, Munakata J, Powers JM, Price D, Vigersky RA. The cost-effectiveness of real-time continuous glucose monitoring (RT-CGM) in type 2 diabetes. J Diabetes Sci Technol.2016;10(4):898-904. doi: 10.1177/1932296816628547. Fitch K, Pyenson BS, Iwasaki K. Medical claim cost impact of improved diabetes control for Medicare and commercially insured patients with type 2 diabetes. J Manag Care Pharm.2013;19(8):609-620, 620a-620-d. doi: 10.18553/jmcp.2013.19.8.609. Juarez D, Goo R, Tokumaru S, Sentell T, Davis J, Mau M. Association between sustained glycated hemoglobin control and healthcare costs.2013;5(2):59-64. Wagner EH. Effect of improved glycemic control on health care costs and utilization. JAMA.2001;285(2):182-189. doi: 10.1001/jama.285.2.182. Gilmer TP, O’Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care.1997;20(12):1847-1853. Vigersky RA, Fonda SJ, Chellappa M, Walker MS, Ehrhardt NM. Short- and long-term effects of real-time continuous glucose monitoring in patients with type 2 diabetes. Diabetes Care.2012;35(1):32-38. doi: 10.2337/dc11-1438.

How do I get a prescription for a CGM?

How to Get a CGM After Receiving a Prescription – What Is Cgm In Diabetes Firstly, it has to be mentioned that getting a CGM can be very expensive. The starter kit for a system can cost hundreds of dollars, plus you have to pay for sensors on top of that, The cost of a CGM will vary depending on the brand and on your insurance coverage.

  1. In some instances, your doctor may want you to use a CGM for just a brief period to get a better understanding of how your blood sugar reacts to different factors.
  2. If this is the case, then you may be able to get a CGM at a discounted cost at the doctor’s clinic.
  3. However, in most cases, a patient with use a CGM for a long period as part of their daily diabetes management.

Once you have a prescription for a continuous glucose monitor, your insurance may require prior authorization, Your healthcare provider will provide this to your insurance. Some CGMs can be provided through your pharmacy. Other CGMs may be labeled as durable medical equipment, so you have to get them through a medical supplier.

Can I get a CGM for type 2 diabetes?

Continuous Glucose Monitoring in Type 2 Diabetes Is Not Ready for Widespread Adoption There is great interest in technology to improve health; however, new devices do not always live up to the hype. Although continuous glucose monitoring may benefit patients with type 1 diabetes mellitus, there is limited evidence that it offers similar benefits in patients with type 2 diabetes, regardless of whether they are taking insulin.

  • Rather than directly measuring blood glucose levels, continuous glucose monitoring devices track levels indirectly by measuring interstitial fluid glucose levels via a subcutaneous sensor attached to an external transmitter located on the upper arm or abdomen.
  • Some monitors communicate continually with a receiver such as a smartphone and will send alerts for hyperglycemia or hypoglycemia.

Flash glucose monitoring devices (e.g., Freestyle Libre) do not notify patients but transmit data when the receiver is in close proximity to the transmitter. Continuous glucose monitoring can alert patients with type 2 diabetes that they are becoming hypoglycemic, especially those using insulin who are at risk of severe hypoglycemia requiring urgent medical care.

Although three studies have shown fewer episodes of hypoglycemia with continuous glucose monitoring, the ability to decrease the risk of severe hypoglycemia has not been demonstrated. – No long-term studies have been performed to determine whether continuous glucose monitoring improves patient-oriented outcomes in type 2 diabetes.

Compared with finger-stick monitoring, continuous glucose monitoring has not been shown to improve AlC levels after six months in patients receiving multiple daily insulin injections (7.7% vs.8.0% in one study and 8.4% vs.8.3% in another study)., In a randomized study of 158 patients, there was no difference in overall or diabetes-specific quality of life at six months between patients using continuous glucose monitoring and those who were self-monitoring.

The cost of continuous glucose monitoring ranges from $2,500 to $6,000 per year. A flash reading device costs approximately $100, with replaceable sensors costing another $120 to $200 monthly. Other devices cost $1,000 to $1,400, with replaceable sensors costing an additional $35 to $100 every seven to 10 days.

Yearly battery replacement costs about $500. The cost-effectiveness of continuous glucose monitoring in patients with type 2 diabetes has not been studied. Currently, Medicare pays for continuous glucose monitoring only in patients receiving insulin via a pump or multiple daily injections who require four or more daily finger-stick glucose measurements.

  1. Insurance companies, if they provide coverage, may require a letter of medical necessity and possibly additional documentation.
  2. Continuous glucose monitoring has a few potential advantages.
  3. The ability to get in-the-moment glucose readings without a finger stick may be appealing to patients.
  4. Physicians may appreciate the longitudinal data on blood glucose excursions that the devices offer.

However, as with other technology introduced into health care, the promise that more data will lead to better patient outcomes has not yet been realized. Most people with type 2 diabetes do not require self-monitoring of blood glucose, and unnecessary monitoring not only wastes money but can negatively impact quality of life.

  1. Until we have research supporting continuous glucose monitoring for patients with type 2 diabetes, especially those not receiving regular insulin injections, there are no patient-oriented benefits to justify its great expense and additional hassles for patients and physicians.
  2. Editor’s Note: Dr.
  3. Shaughnessy is an assistant medical editor for AFP,

: Continuous Glucose Monitoring in Type 2 Diabetes Is Not Ready for Widespread Adoption

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