COMMENTARY

3 Myths About Continuous Glucose Monitoring

Anita N. Swamy, MD

Disclosures

November 03, 2020

Being diagnosed with type 1 diabetes is a harrowing experience for patients. They may become overwhelmed with uncertainty and questions: Do I have to prick my finger multiple times per day? What happens if I go too low and no one is around to help? How do I know when to give myself insulin?

It's our job to educate patients about the disease and ease their concerns by arming them with the best tools and resources to help manage their diabetes. There is one tool that I believe all physicians absolutely must prescribe at diagnosis to help patients live their best possible life: a continuous glucose monitoring (CGM) system.

CGM uses a tiny wearable sensor to automatically send glucose levels to a compatible smart device or receiver, giving patients real-time data without the need to prick their finger. It's considered one of the biggest technological advances in diabetes, yet only 1 in 4 patients with diabetes is currently using CGM.

Why are so few clinicians choosing to prescribe this life-changing technology? Here are three myths about CGM that I hear most often.

Myth #1: CGM Outcomes Are Not Proven

Given that CGM is still a relatively new technology, patients and providers may be wary of its overall effectiveness compared with traditional finger sticks. But studies have shown that regular CGM use is associated with a reduction in hypoglycemic incidents. In fact, the HypoDE study showed a 72% reduction in the average number of hypoglycemic events in patients on CGM over a period of 1 month.

These studies also showed an increase in time spent in range, which is quickly becoming the new standard of measurement for diabetes — but it can only be measured with CGM technology. CGMs provide hundreds of readings each day, giving clinicians a more accurate, trending view of a patient's daily habits so they can develop customized care plans that drive the most effective results.

Myth #2: They Are Difficult to Use and Understand

Advances in technology have made CGMs smaller, more accurate, and rich with advanced features. The more features, the more time physicians think they will have to spend learning and training patients how to use them; but many CGM systems are very intuitive and easier to use and understand than one might think.

For providers, I recommend first wearing the device yourself. Physicians with firsthand knowledge of the technology are going to be better equipped to train patients and answer any questions they may have when first prescribed a CGM. Even my least digitally savvy patients have been able to use the technology with minimal training.

Once up to speed, patients who may have been hesitant to use CGM often return to say that it's a game changer, especially because they are able to avoid frequent and painful finger sticks. Others are relieved to feel some of the burden of diabetes management lift off their shoulders, as they can rely on features such as predictive alerts and alarms to help warn of a potential hypoglycemic event, or remote monitoring capabilities that allow caregivers to see glucose levels from afar.

That said, not all CGM devices are created equal; some do even more. For example, some CGMs can integrate with insulin pumps to create hybrid closed-loop systems that automatically dose or suspend insulin based on real-time glucose readings from the CGM sensor. This can be a huge benefit for people with diabetes on intensive insulin therapy. You'll want to do your research to ensure that you're prescribing the device that fits each patient's needs.

Myth #3: CGMs Are Too Expensive

Significant improvements have been made to the overall cost and availability of CGM. While there is a perception that CGM devices cost more than finger sticks, when looking at overall patient outcomes, CGMs are more cost-effective than test strips. Additionally, CGM is covered by Medicare and 98% of private insurance in the United States. Medicaid coverage is also expanding for some devices.

Diabetes requires around-the-clock monitoring and care, which is extremely difficult to achieve without the use of CGM. Some physicians may think that prescribing CGM at the time of diagnosis holds patients back from learning more about the disease, but I believe that simply isn't true. The data and insights provided by CGM to patients are unparalleled; patients immediately begin to see how their daily lifestyle and activities affect their glucose levels, and they learn to make changes in real time to maximize time spent in range and lower A1c, leading to better outcomes and quality of life.

Some CGMs are approved for use in patients as young as 2 years old, and with Medicare making the technology available to seniors, patients of all ages can now benefit.

With CGM, patients know exactly where their glucose levels are at any given time, offering peace of mind for patients and caregivers alike. Without CGM, providers are operating blindly, simply guessing as to what a patient with diabetes may need or may be experiencing. It's time for providers to look beyond these myths and prescribe CGM to their patients with type 1 diabetes at the time of diagnosis.

Anita N. Swamy, MD, is an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and a medical advisor for the Juvenile Diabetes Research Foundation (JDRF). She is passionate about diabetes education and technology, believing that education empowers clinicians and patients and is the key to successful management.

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