Diabetes Self-Management Blog

A new study, funded by the Juvenile Diabetes Research Foundation (JDRF) and published online this month in The New England Journal of Medicine, has found that using a continuous glucose monitoring (CGM) system can lower blood glucose levels significantly in six months in adults with Type 1 diabetes.

The study enrolled 322 children, teenagers, and adults with Type 1 diabetes, randomly assigning half the participants to use CGM devices. The CGM group members were instructed to verify glucose levels with a blood glucose check before making treatment decisions, while the people who did not receive CGM devices (the “control group”) were given blood glucose meters and test strips and instructed to check their blood glucose levels at least four times a day.

At the end of six months, the adults (ages 25 to 72 years old) who were assigned to use continuous glucose monitors had a reduction of about half a percentage point in their HbA1c levels—a significant change compared to the control group, which saw a slight increase in HbA1c levels. This improvement was achieved without a difference in hypoglycemia, or low blood glucose levels, between the two groups.

Statistically significant reductions in HbA1c were not seen in the two groups of younger people (ages 8 to 14 years old and 15 to 24 years old) who participated in the study. However, the people in these age groups used their CGM devices only 50% of the time or less. The adult group, which did see a significant drop in HbA1c levels, used the device more than 85% of the time. In all age groups, people who used the CGM device at least six days a week lowered their HbA1c levels.

The researchers concluded that “continuous glucose monitoring improves glycated hemoglobin [HbA1c] levels and may enhance the management of Type 1 diabetes in adults who have the motivation to use this technology and the capability to incorporate it into their own daily diabetes management.”

This study may play in important roll in getting health insurance companies to reimburse the cost of CGM devices for adults with Type 1 diabetes. CGM coverage is currently considered on a “case by case” basis by most insurance companies.

There are currently four CGM systems on the market in the United States: the DexCom Seven, the FreeStyle Navigator, the Medtronic MiniMed Guardian REAL-Time System, and the Medtronic MiniMed Paradigm REAL-Time System, in which the receiver is combined with an insulin pump. The Seven, the Navigator, and the Paradigm systems were all used in this new study.

You can find links to more information about the “CGM Anti-Denial Campaign,” the JDRF’s guide to getting case-by-case coverage for a CGM, and more in our recent entry “What We’re Reading: CGMS Denial Week.” And you can find the new study itself online here.

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Comments
  1. Dear Tara.

    How expensive are these continuous sensors. I use test strips about 6 times a day @ $0.80 per shot or about $5.00 per day. I could see that continuous would be much better the more so if they become reliable enough for use in an automatic control loop using an insulin pump.

    Posted by CalgaryDiabetic |
  2. Hi Calgary

    The sensors tend to run about $60 each, U.S. dollars. Your best bet is to contact the companies that have CGMS approved and ask about cost and how long the sensors are approved for. The ones I use time out after seven days, but my CGMS (as well as the others) can be tricked into lasting longer. (Psst! The companies can’t tell you that!) You would have to add the cost of some strips to calibrate the CGMS to the cost of the sensors. A good place to go to for information is diabetescgms at yahoo groups. Go to , click on “groups” and search for “diabetescgms.” Just put in a request to join and you should be admitted to the group.

    Jan

    Posted by Jan Chait |
  3. My name is Jessica and I work at Guidepoint Global, an independent healthcare research firm in NYC. We are currently conducting research on insulin pumps and we were hoping to survey certified diabetes nurse educators. If you are interested in participating please email me at jdonaldson@guidepointglobal.com

    Thanks and have a great day!

    Posted by Jessica Guidepoint Global |
  4. Dear Tara
    These CGMS systems are only available in U.S and some developed countries. 50% of type 1 patients around the world don’t have acesss to insulin pumps forget about the CGMS. The companies say there are not enough patients who can afford these in those countries. Insulin pumps have been around for many years. Maybe now the manufacturing companies of these pumps should think of reducing there profit margins and providing benefits to the masses.

    Posted by Danish |
  5. I HAVE WORK THE MM CGMS FOR OVER A YEAR AND LOVE IT AND HAVE NOT HAD VERY MANY PROBLEMS WITH IT. WHEN TRYING A SYSTEM A PERSON NEED TO WEAR ONE FOR AT LEAST A WEEK OR LONGER TO GET THE TRUE FEEL OF THE WHOLE SYSTEM. MY INSURANCE PAYS FOR THE SENSORS AND NOW I GOT A NEW RECEIVER AND THEY ARE PAYING FOR THAT. MY A1C WENT DOWN FROM 7.0 to 6.3 AND WILL CONTINUE TO GO DOWN RIGHT NOW I NEED TO GET FOUR MORE TEETH PULLED SO AM HAVING SOME PROBLEMS WITH MY SUGARS. I FOUGHT FOR ALMOST NINE MONTHS TO GET THE INS. TO PAY AND AFTER WE HAD AN APPEAL CONFERENCE CALL AND ONE OF THE DOCTORS WAS ON THE PHONE NAD HAD MOST OF HIS PATIENTS ON THE CGMS I ASKED HIM QUESTIONS AND BEFORE THE CALL WAS OVER I NEW IT WOULD BE APPROVED.

    Posted by Mary R. Bly |
  6. I have used a CGMS for 20 months..almost 2 years. I now use it 24/7. Because it will warn me when my blood glucose is getting too low (before I start having symptoms, espcially since I am mostly unaware of low glucose until it is too late) it is the only way for me to get good control I have been paying for the myself (I use minimed paradigm pump and sensors) and I know for a fact the sensors are $35. each (boxes of 4 or 10)The recommendation is for three days use, so about $10/day. However, you can use them longer (though not FDA approved for longer than three days) and you cost goes down. I hope this is helpful. Mine has saved my life more than once.

    Posted by idocmadden |
  7. I have been using the MM CGMS along with the paradigm pump for 2 years now. I absolutely love it and it has saved my life on more than one occasion. Prior to the CGMS i had to receive emergency treatment for hypoglycemia quite often. Since using the sensors my risk for severe hypoglycemia has significantly decreased. The major frustration is that my insurance company has denied payment. I am going to keep fighting as I am trying to get pregnant and absolutely will need the CGMS!

    Posted by laura |
  8. MsPincushion says please don’t leave the type 2’s out of testing. We deserve to be part of the testing too. There are those of us on insulin that would also benefit from continious blood glucose monitoring!

    We work just as hard to keep our numbers in the right range! It’s just as difficult for us!

    Posted by MsPincushion |
  9. The few glitches that I associate with the CGSM are worth it for all the benefits I get out of it. Sure, I’ve sweat it off and had to have my kids and husband do a search of the backyard to find it. However, my A1c has dropped from 7.2 to 6.5. I find that I am alerted when I forget a bolus for a meal sooner than I would have before. Before the CGSM I wouldn’t realize I had forgotten a bolus until I started experiencing the “sick” feeling associated with ketones. I haven’t had the drastic blood sugar swings from 40 to 400 that I had continually prior to the CGSM. I also remember testing 10 times in a row withing 20 min. prior to bedtime to see if my bs was dropping or raising, then praying that I would wake up if I needed to test again and either take more insulin or drink some juice. My CGSM has brought me (and my husband)peace of mind. The alerts for both high and low bs readings are truly a blessing.

    Posted by Diana |

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