Continuous glucose monitors proven cost-effective, add to quality of life for diabetics

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Northerner

Northerner

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Type 1
Continuous glucose monitors (CGM) offer significant, daily benefits to people with type 1 diabetes, providing near-real time measurements of blood sugar levels, but they can be expensive. A new study by researchers from the University of Chicago Medicine, based on a 6-month clinical trial, finds that use of a CGM is cost-effective for adult patients with type 1 diabetes when compared to daily use of test strips. The results are well within the thresholds normally used by insurance plans to cover medical devices. During the trial, CGMs improved overall blood glucose control for the study group and reduced hypoglycemia, or low blood sugar episodes.

The study, published April 12, 2018 in Diabetes Care, a journal from the American Diabetes Association, also simulated the costs and health effects of CGM use over the expected lifetime of patients. It showed that CGMs also increased quality of life by extending the amount of time patients enjoy relatively good health, free of complications.

https://www.sciencedaily.com/releases/2018/04/180412102930.htm
 
Do you think the folk at NICE read Diabetes Care from ADA? If not, post it to them.

Though don’t forget, all diabetes stuff, including insulin, and all the kit is more expensive in the US, so cost calculations may be different.
 
Benny G said:
I use libre with the Bluetooth 'Night rider' and 'Xdrip+' on my smart phone to have alarms through the night and through the day.
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Sounds ideal, what's the cost of Night Rider if you don't mind me asking.
 
mikeyB said:
Do you think the folk at NICE read Diabetes Care from ADA? If not, post it to them.

Though don’t forget, all diabetes stuff, including insulin, and all the kit is more expensive in the US, so cost calculations may be different.
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NICE always review all studies in the literature when reviewing a topic, wherever they take place in the world.

This is a smallish short term study though. 158 patients over 6 months. It’s very encouraging, and it will add to the gathering weight of evidence, but we can’t get our hopes up too much yet I’m afraid. Especially where benefits are quoted as ‘quality of life’. If it demonstrated a significant HbA1c drop across the board that would really help the bean counters see the light. A quick scan on phone, but I didn’t see A1c reduction quoted in headline/summary.
 
The other question I would have is how do you attach it, Benny? The folk who use it are well impressed. And do you wear it all day?
 
everydayupsanddowns said:
If it demonstrated a significant HbA1c drop across the board that would really help the bean counters see the light. A quick scan on phone, but I didn’t see A1c reduction quoted in headline/summary.
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That's me out then :( Using the Libre certainly improved my quality of life, but the medics would have a pink fit if my HbA1c dropped any lower 😱 It wouldn't, it would just be representing a smoother, in-range curve much more of the time. For example, I had quite a bad hypo at lunchtime because, despite years of contrary experience, injecting my insulin early dropped my levels too quickly, too soon and I was halfway through my roast beef salad sandwich when the room turned into a strobing discotheque with the heating turned up high 😱 With CGM or Libre I would have spotted that approaching and prevented it from happening.
 
I have recently got the use of CGM & I also bought my own Libra system & sensors. It was like a ".BIG DAY OFF". My head was free for a change after more than 50years of finger sticks. I still do them but a day off 😎o_O
 
Northerner said:
That's me out then :( Using the Libre certainly improved my quality of life, but the medics would have a pink fit if my HbA1c dropped any lower 😱 It wouldn't, it would just be representing a smoother, in-range curve much more of the time. For example, I had quite a bad hypo at lunchtime because, despite years of contrary experience, injecting my insulin early dropped my levels too quickly, too soon and I was halfway through my roast beef salad sandwich when the room turned into a strobing discotheque with the heating turned up high 😱 With CGM or Libre I would have spotted that approaching and prevented it from happening.
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Yup. It’s the problem with always relying on old data for the evidence base isn’t it. Things like ‘time in range’ make so much sense to us, but there isn’t an equivalent of DCCT (the ‘intensive insulin therapy’ trial which first ‘proved’ reduced A1c had the effect of reducing long term complications) so A1c remains the benchmark around which interventions and clinical data are measured because it is easy to monitor, easy to compare, and has history in the evidence base. It’s difficult to analyse other (more useful!) measures across multiple trials when trying to establish whether CGM is cost effective long term - especially as it’s so darned expensive. If CGM was cheaper it would be FAR easier to make the case for wider use :(:(:(
 
Like the Libre phone App, the Xdrip+ app seems to be just for Android phones, at least initially. I don’t like Android because of the shaky security. There is an iOS app called sugarmate, which seems to fit the bill, but will it talk to the Night rider?
 
mikeyB said:
Like the Libre phone App, the Xdrip+ app seems to be just for Android phones, at least initially. I don’t like Android because of the shaky security. There is an iOS app called sugarmate, which seems to fit the bill, but will it talk to the Night rider?
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If you have an iPhone 7 or above the NFC is unlocked enough for Abbot’s shiny new iOS app.
 
I’ve got the iOS phone app for the Libre, and very neat it is too. I need something that will give me alarms cos I don’t wake up when I’m hypo in the night any more. This looks like a fairly low cost way of doing it.
 
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