In the nation’s battle against the diabetes epidemic, the weapon that is aggressively delivered to patients is only a quarter small and worn on the stomach or arm.
A continuous blood glucose meter contains a tiny sensor that is placed just under the skin so that patients no longer have to prick their fingers to check blood glucose every day. The monitor constantly tracks glucose levels, sends readings to the patient’s cellphone and doctor, and notifies the patient if readings are too high or too low.
Almost 2 million people with diabetes are wearing the monitors today, twice as many as in 2019, according to investment firm Baird.
There is little evidence to suggest that continuous glucose monitoring (CGM) results in better outcomes for most people with diabetes – the estimated 25 million US patients with type 2 disease who do not inject insulin to regulate their blood sugar. say health experts. Still, manufacturers, as well as some doctors and insurers, say the devices help patients manage their diabetes by providing near-instantaneous feedback on diet and exercise changes compared to once-a-day fingerstick tests. And they say it can reduce costly complications of the disease like heart attacks and strokes.
Continuous glucose monitors are not cost-effective for type 2 diabetes patients who are not using insulin, said Dr. Silvio Inzucchi, director of the Yale Diabetes Center.
Sure, it’s easier to put a device on your arm every two weeks than multiple fingersticks, which cost less than $ 1 a day, he said. “However, the price of these devices is not justified for routine use by the average person with type 2 diabetes.”
Without insurance, the annual cost of using a continuous glucose monitor is anywhere from nearly $ 1,000 to $ 3,000.
Lower prices help drive usage
People with type I diabetes who do not produce insulin need the frequent data from the monitors to inject the correct dose of a synthetic version of the hormone through a pump or syringe. Because insulin injections can cause life-threatening blood sugar drops, the devices also warn patients when this happens, especially when they are asleep.
People with type 2 diabetes, another disease, make insulin to control post-meal recovery, but their bodies don’t react as violently as people without the disease. About 20% of type 2 patients still inject insulin because their bodies are not making enough and oral medications cannot control their diabetes.
Doctors often recommend diabetes patients have their glucose tested at home to see if they are meeting treatment goals and to learn how medication, diet, exercise, and stress affect blood sugar levels.
The crucial blood test doctors use to monitor diabetes in people with type 2 disease is called hemoglobin A1c, which measures average blood sugar levels over long periods of time. Neither fingerprint tests nor glucose monitors are viewing A1c. You cannot because this test will have a large amount of blood and will need to be done in a laboratory.
The continuous glucose monitors also do not measure blood sugar. Instead, they measure the level of interstitial glucose, which is the level of sugar in the fluid between the cells.
Companies seem determined to sell the monitors to people with type 2 diabetes – those who inject insulin and those who don’t – since it’s a market of more than 30 million people. In contrast, around 1.6 million people have type 1 diabetes.
A fall in prices has helped drive demand for monitors. Abbott FreeStyle Libre, one of the leading and most affordable brands, costs $ 70 for the device and about $ 75 per month for sensors that need to be replaced every two weeks.
Another factor was the expansion of insurance coverage.
Almost all insurers cover continuous glucose monitors for people with type 1 diabetes, for whom this is a proven lifesaver. According to Baird, nearly half of people with type 1 diabetes today use a monitor.
A small but growing number of insurers cover the device for some type 2 patients who do not use insulin, including UnitedHealthcare and Maryland-based CareFirst BlueCross BlueShield. These insurers say they have seen initial success with members using the monitors with health advisors to help keep their diabetes under control.
The few studies – mostly small and paid for by device manufacturers – examining the effects of monitors on patient health show conflicting results when it comes to lowering hemoglobin A1c.
Still, Inzucchi said, the monitors have helped some of his patients who don’t need insulin and who don’t like pricking their fingers change their diets and lower their glucose levels. Doctors said they saw no evidence that the readings led patients to make sustainable changes to their diet and exercise routines. They said that many patients who don’t use insulin may be better off taking a diabetes education class, going to a gym, or seeing a nutritionist.
“I don’t see the added value of CGM in this population based on current knowledge,” said Dr. Katrina Donahue, director of research in the Family Medicine Department at the University of North Carolina. “I’m not sure if more technology is the right answer for most patients.”
Donahue co-authored a landmark 2017 study in JAMA Internal Medicine that found no benefit in lowering hemoglobin A1c in people with type 2 diabetes after a year of regular glucose monitoring with finger-stick testing for people with type 2 diabetes.
She assumes that the measurements have hardly changed the eating and exercise habits of the patients in the long term – which probably also applies to continuous glucose monitors.
“We need to be careful about how we use CGM,” said Veronica Brady, a certified diabetes advisor at the University of Texas Health Science Center and spokesperson for the Association of Diabetes Care & Education Specialists. The monitors are useful if used for a few weeks, when people switch medications that can affect their blood sugar levels, or when they don’t have the skill to do finger-stick tests.
However, some patients, like Trevis Hall, credit the monitors for helping them get their disease under control.
Trevis Hall insurer gave him a free monitor last year as part of a diabetes control program. He says it doesn’t hurt if he attaches the monitor to his stomach twice a month.(Lynne Shallcross / KHN)
Last year Hall’s UnitedHealthcare plan gave him a free monitor as part of a diabetes control program. He said it doesn’t hurt if he attaches the monitor to his stomach twice a month.
The data showed Hall, 53, of Fort Washington, Maryland, that his glucose reached dangerous levels several times a day. “It was alarming at first,” he said of the alerts the device would send to his phone.
For months, the readings helped him change his diet and exercise routine to avert these spikes and bring the disease under control. Nowadays it means taking a brisk walk after a meal or having a vegetable for dinner.
“It made a huge difference in my health,” Hall said.
This market is going to explode
Device manufacturers are increasingly promoting them to encourage healthier eating and exercise.
Manufacturers are spending millions of dollars getting doctors to prescribe continuous glucose monitors, and they advertise directly to patients on the internet and in television commercials, including a spot with singer Nick Jonas during this year’s Super Bowl.
Kevin Sayer, CEO of Dexcom, a leading manufacturer of monitors, told analysts last year that the noninsulin type 2 market was the future. “Our team often tells me that this market will explode if it goes. It won’t be small and it won’t be slow, ”he said.
“Personally, I believe that patients will be using it all the time at the right price and with the right solution,” he added.
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