CGMs Have Come of Age
Dec 1, 2017, 08:30 AM
Has recommending personal CGM become a standard of care in your practice? Are you hesitant to recommend because of accuracy concerns of the initial sensors? Has this impacted your recommendation of these products?
With the mean absolute relative difference (MARD) now being closer to 9-11% (even better than the standard deviation of many glucometers) it seems like a no-brainer to encourage the utilization of the sensor within financial constraints. It’s awesome, to say the least, to be able to see the blood glucose trends and not have to spend so much brain power wondering where the glucose value is at any point in time!
At this time, there are two companies to choose from for personal CGM use and one scannable BGM that will populate historical data:
DexCom
- DexCom G5: An independent sensor that can report sensor data to a handheld receiver, a cell phone, and most recently the Tandem insulin pump screen. The ability to set alarms for high and low blood glucose (BG) at the wearer’s discretion provides an added layer of protection against glucose variability when warnings are heeded and acted upon. The cell phone can communicate to other persons as designated (parents from kids, etc.).
- DexCom G4: Available also as an independent sensor, also works with a Tslim pump and Animas G4 pumps that are still under warranty.
It’s awesome, to say the least, to be able to see the blood glucose trends and not have to spend so much brain power wondering where the glucose value is at any point in time!
Medtronic
- The Guardian Sensor 3: Talks to the 670G Medtronic insulin pump. It incorporates the data from the sensor into the decision-making process that is automated for adjusting basal insulin. The accuracy of the Guardian is much improved over the previous Enlite sensor. The greatest advantage appears to be fasting BG which are generally close to the target of 120 mg/dl. Warnings for hypo and hyperglycemia are available. The sensor is worn for up to 6 days at a time.
- Enlite Sensor and 630G pump: Allows for the auto-suspend feature on the pump when a predetermined low BG is sensed. Audio warning for hypo and hyperglycemia are available on the pump. It does not transmit information to a phone or any other person.
New Blood Glucose Monitoring Category: Scannable BGM
- FreeStyle Libre personal to be released December 1. The sensor is the smallest available and provides a glucose measurement every minute and is approved for use for up to 10 days. It does not have alarm capability, nor can it communicate with others to give real-time alerts. It requires a handheld receiver that can be waved over the sensor to obtain data at any time. We suspect a big advantage might be a lower cost compared to other available sensors.
Professional Use or Diagnostic CGM Use:
Dexcom, Medtronic (ipro), Freestyle libre pro) for those who do not want (or cannot afford) to purchase their own. These can provide one to two weeks of continuous data, which enhances knowledge about trends and patterns, and provides excellent information for providers and patients to be able to make better medication adjustments. Check out this information on CPT billing codes.
What a great time to be in the field of technology and diabetes. I gave six talks about technology throughout this fall, and each time I have to change my slides as the technology is changing so rapidly!
For further reading check out:
Fonseca V, Grunberger G, Anhalt H et al. Continuous Glucose Monitoring: A consensus conference of the American Association of Clinical Endocrinologists and American College of Endocrinology. Endocrine Practice: 2016:22(8)1009-1021.
Rodbard D. Continuous Glucose Monitoring: A review of successes, challenges and opportunities. Diabetes Technology & Therapeutics: 2016:18(Suppl 2) S2-3 to S2-13.
About the Author:
Carla Cox is a registered dietitian and certified diabetes educator. She has been a certified diabetes educator for over 25 years, and served as an assistant adjunct professor for 14 years, teaching in areas of sports nutrition and exercise physiology. Currently she works in Missoula, Montana as a diabetes educator in both in- and outpatient settings.
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