People living with diabetes are advised to check their glucose once a day if not taking insulin, or several times a day if they are. Traditionally, this has been done using blood glucose monitors via finger checks. However, Continuous Glucose Monitors (CGM) are quickly becoming a more effective and less painful alternative. The rise in accuracy and availability has seen the Type 1 community fully embrace this technology, but there are plenty of benefits for insulin-dependent Type 2's to consider adopting it. Right now, these CGMs are not commonly approved for those who are not yet taking insulin, or for inpatient use — but recent trends and legislative changes could signal a big shift in this market.
Continuous Glucose Monitors for Inpatient Use
Typically, providers check inpatient blood sugar at the point of care. During the pandemic, the FDA gave emergency authorization to allow hospitals to use two at-home CGMs (Dexcom G6 and Abbott FreeStyle Libre 14-day system) for inpatients. Clinical trials were already in progress, although they were forced to halt the trials because of COVID-19.
Early results from these trials demonstrated less hyperglycemia and hypoglycemia, and greater time in range, but the point of the emergency authorization was to reduce the amount of time providers had to spend in a patient's room. In a post-COVID world, continuous monitoring of inpatient glucose could become increasingly important in many contexts, especially outside of the hospital setting.
For the most part, however, continuous glucose monitoring is used in an outpatient setting.
Benefits of CGM for Multiple Populations
CGM shows a number of benefits over traditional glucose monitoring alone and should be considered more broadly by people living with Type 2 diabetes, as well as Type 1. Here are some of the benefits:
- It provides patients and their doctors with more data. Continuous glucose monitors can tell people how their individual bodies respond to different foods and let them adjust their diets accordingly. It can also help determine the best type and timing of exercise and establish whether a patient is responding to medication. This may even be useful for people with prediabetes, as it can help them determine the best lifestyle changes to keep the disease from developing.
- It has been demonstrated to improve glucose control and outcomes. For example, it has shown a reduction in A1C by 1% for patients with T2D not taking insulin. Patients have also shown increased physical activity, improved overall control, and a significant reduction in acute diabetes events.
- Ease of use. There is no need to do periodic glucose testing. Instead, the patient can check the sensor before administering insulin if not using a pump. This also means the elimination of needles, which make many people uncomfortable. If using a pump, the CGM system can directly control the pump and adjust the dosage automatically.
- An increased sense of control. By having direct access to their own real-time data, patients can feel a greater sense of control over their disease. This can reduce mental health symptoms and help patients get better and more stable outcomes.
- Continuous glucose monitoring has also proved useful in detecting and treating gestational diabetes.
There are arguments in favor of CGM becoming the standard of care for most Type 2 diabetics. There are, of course, also arguments against it, and numerous barriers to adoption.
Barriers to Adoption of CGM for Type 2 Diabetics
A number of things stand in the way of the wide-scale use of continuous glucose monitoring. One of them is the lack of approval for inpatient use, but it is likely that full approval will come about after the pandemic. However, there are some other barriers to worry about:
- Lack of awareness. A lot of people with diabetes and even some doctors are not aware the devices are available or think they are more expensive than they are. Many patients don't realize how much easier CGM is to use.
- Cost. The devices are not cheap, although their price is coming down with time. Wider adoption of the technology should further drive down prices. The sensors, which have to be replaced about every two weeks, are also a cost.
- Insurance. As already mentioned, most insurers only cover CGMs for limited populations. Health plans need to be convinced that this is baseline technology (and will save them money by reducing acute events). Medicare has, thankfully, expanded access to the Libre 2, which is now accessible to all diabetic Medicare patients.
- Value. For people with well-managed Type 2 diabetes, it can be reasonably argued that the cost of the devices is not worth it. This might slow adoption, limiting it somewhat to those who have more difficulty keeping their glucose levels stable. Of course, there might be significant value in providing the devices to people who have been recently diagnosed to help them and their nutritionist work on a more personalized diet plan.
- Anxiety. Patients are often anxious about using a medical device and may not understand how CGM works and what it does. They may need their hands held through the process. A coach can help in these cases by talking the patient through how to use the device and helping them analyze the data.
All of these barriers can be overcome with time, education, and support. Cost in particular is continuing to come down.
How Will Things Develop?
There are likely to be continued improvements in the technology over time, both in an inpatient and outpatient setting. For example, some systems now get rid of the handheld reader in favor of an app installed on the patient's smartphone.
The sensors are also becoming more comfortable and less invasive. Patients will be able to forget they are wearing the devices until they need to check their levels. A variety of coaching tools and software designed to help patients start on the device and subsequently analyze their data will only improve, and AI assistance will help patients get even more control over their lives. It's likely that in the not too distant future, CGMs will become the standard of care for Type 2 diabetes and even prediabetes, improving outcomes and helping patients live better lives.
CGMs are already used by many Type 1 diabetics, and it's time for Type 2 patients to adopt this amazing technology to gain control over their lives and futures. The main barrier is a lack of awareness and understanding of just how much a CGM can make their lives easier and better and help them monitor their glucose levels easily and seamlessly.