Curious about CGM for diabetes? You may have heard about CGM at one point or another; maybe you’ve had an opportunity to give it a trial run, or maybe you’ve been able to wear CGM temporarily through your doctor’s office. CGM stands for continuous glucose monitoring, and it’s been making a lot of headway in the diabetes world. For the most part, CGM has been primarily geared towards people with type 1 diabetes, but more and more people with type 2 diabetes are also using CGM these days. And we’ve had an opportunity to talk with Kevin Sayer, CEO of Dexcom, a company that manufactures and distributes CGM.
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In case you’re not entirely sure what CGM is, here’s a brief overview: CGM is a way of automatically tracking glucose levels throughout the day and night, 24 hours a day. Using CGM allows you to see your glucose levels at any time, and is the equivalent of doing about 288 finger-sticks a day (try doing that many finger-sticks with your meter!).
A CGM works through a tiny sensor that you insert under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor checks glucose every few minutes. A transmitter wirelessly sends the information to a monitor, which may be a separate device, a smartphone or tablet, or an insulin pump.
At this point, you might be thinking, “This sounds all well and good, but why should I consider using CGM? What’s in it for me?” Both are excellent questions. For starters, CGM gives you insight into how various factors, such as food choices and portions, physical activity, medications, stress and illness impact your glucose levels. “In my experience with type 2 diabetes patients using (Freestyle) Libre, it has allowed them to understand cause and effect. For example, during stressful times, glucose trends upwards. Physical activity lowers glucose and different foods lead to different responses,” states Lorena Drago, a registered dietitian (RD) and certified diabetes care and education specialist (CDCES; and the Food Editor for Diabetes Self-Management).
Doing a finger-stick with your meter is a snapshot of your blood glucose level at that particular moment in time. And there’s nothing wrong with that! But if you’re checking your blood sugars once or twice a day, you have no idea what’s happening the rest of the time. In contrast, CGM is more like a video, capturing your glucose levels over a continuous 24-hour period. For the most part, CGM replaces finger-sticks, which is an added bonus. (Finger-sticks may be needed to calibrate your CGM or help to validate a CGM reading.)
What else can CGM do for you? It can give you a heads up that your glucose is heading in the wrong direction, trending either too low or too high. This means that you get a low or high alert, giving you time to take corrective action and head off a potentially dangerous situation.
Currently, four companies manufacture and distribute CGMs:
· Dexcom: Dexcom G6
· Abbott: FreeStyle Libre
· Medtronic: Guardian Connect
· Senseonics: Eversense
Each of these CGM systems have unique features in terms of length of sensor wear, calibration, data display and insurance coverage (including Medicare). For more information about a specific system, visit the manufacturer’s website, listed above. Some of the CGM device integrate with insulin pumps and smart insulin pens, as well (a factor to consider if you are thinking about using CGM).
Recently, we had an opportunity to talk with Kevin Sayer, the President and CEO of Dexcom. He had a lot to share about CGM and where Dexcom is headed. “We’ve achieved a lot of goals,” Sayer stated emphatically. “We’ve doubled our manufacturing capacity — and will do so again by July 1. We no longer have inventory issues. And we’re on track for taking CGM technology to more people.”
CGM has played an integral role during the COVID-19 pandemic. In March of 2020, the U.S. Food and Drug Administration (FDA) issued a temporary guidance allowing an expanded use of noninvasive remote monitoring devices during the pandemic, including the use of CGM in hospital settings. Sayer shared a couple of the learnings from the use of Dexcom, specifically:
· It translated to a major time savings for nurses: Instead of having to do individual blood glucose finger-sticks on everyone, a nurse was able to follow 10 patients on CGM at one time, using an iPad.
· There was a big reduction in the use of PPE (personal protective equipment), number of finger-sticks needed, and time spent administering insulin drips.
Sayer added, “Anecdotally, we found that patients on Dexcom did much better — they had better outcomes, such as maybe not having to go on a ventilator.” That’s big!
CGM was also used with COVID-19 patients who didn’t have diabetes. The stress of having the virus caused some patients to have high glucose levels. Putting these patients on CGM helped hasten the detection of glucose spikes, allowed earlier intervention, and even helped to prevent the disease from progressing. (High blood glucose levels increase susceptibility to infection and can make it more challenging for someone to recover from an illness such as COVID-19).
The COVID-19 pandemic has affected many of the Centers for Medicare & Medicaid Services regulations; one of these has been the waiving of certain clinical criteria to allow those with diabetes easier access to CGM. These waived criteria include:
· In-person clinic visits
· Specific lab tests for C-peptide or auto antibodies, or documentation of frequent finger-sticks.
One of the barriers for those with type 2 diabetes is lack of insurance coverage for CGM. Barbara Roberts, a certified diabetes care and education specialist in Birmingham, Ala., admits that, “Some of the benefits of CGM include being able to identify patterns and being able to see time in range; however, some insurance doesn’t cover CGM in my state of Alabama for Medicaid, and those are likely the ones needing CGM the most.”
Insurance coverage for CGM will vary based on the type of health plan that you have. In general, having type 1 diabetes makes it easier to get CGM, whereas those with type 2 diabetes can have a harder time, especially if they don’t take multiple injections of insulin every day. Medicaid recipients may also struggle to get CGM covered, and much of that is dependent on state programs regulations. Medicaid programs, in general, require a diagnosis of diabetes, regular visits with a healthcare provider and evidence of at least three finger-sticks daily. Some states, such as Massachusetts, do not cover CGM use in those with type 2 diabetes.
With the recent Medicare coverage of CGM for those with type 2 diabetes using insulin, Sayer says, “That makes really good sense, and a lot of private payers are following suit.” Wearing CGM “full time,” he adds, can lead to $5,000 in cost savings and “patients and their providers become more engaged in their care — we can actually see what’s going on.”
“I’m a huge fan and advocate of type 2 and prediabetes daily use of CGM! It’s the best self-management tool for both and it more than pays for itself,” says Tammy Murphy Hargett, RD, CDCES, from Colorado Springs, Col. “Empowering people and providing them with the information they need to be able to adjust their behaviors is the key to a healthier life. Primary-care providers should be writing prescriptions for CGM just as much as glucometers and strips,” she adds.
If you have type 2 diabetes and are interested in using CGM, talk with your diabetes educator or your provider. It’s also important to contact your health plan to find out if they cover CGM and, if so, if they have a preferred brand of CGM.
Sayer shared what the year ahead will look like for Dexcom. The G7 will launch, and, as he said, “It will be a completely different system. With G6, everything changed. And it will change again with G7.” These changes include:
· A smaller sensor (a little smaller than a quarter)
· A disposable transmitter
· A one-button insertion device
· Improved cyber-security
· Integration with insulin pumps and smart pens
There’s no specific launch date yet, according to Sayer. And the G6 sensors will still be made. Will there be an extended sensor wear for the G7? Dexcom is working on a longer-labeled application, possibly for 14 or 15 days. But the length of wear is determined by the accuracy of the data, so more to come.
Dexcom has differentiated itself from its CGM competitors in several ways. They were the first to integrate with a smartphone, connect with other devices such as insulin pumps and smart pens, and not require finger-sticks for treatment and management decisions.
If you’ve been hesitating to think about using CGM, maybe it’s time to talk it over with your healthcare team. CGM use helps to increase time in range (the percent of time that your glucose levels stay within your target range), improve quality of life and improve your diabetes management, overall. These are certainly things to think about! If you’re still unsure or if your health insurance doesn’t cover it, you might talk with your provider or diabetes educator about using a professional CGM periodically. (Professional CGM is a device owned by your healthcare team that you can wear for seven to 14 days, and then return the device to your provider’s office for downloading.)
Want to learn more about CGM? Read “CGM for Diabetes” and “Sensing the Big Picture With Continuous Glucose Monitoring” and watch “Continuous Glucose Monitoring.”
(Image: Dexcom G6 family. Courtesy of Dexcom.)
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