Is CGM for everyone with diabetes?

[Eddy Edson]

Debate from the EASD conference in Stockholm: https://www.medscape.com/viewarticle/981908

STOCKHOLM, Sweden — Whether continuous glucose monitoring (CGM) is for "all" — and if not, for whom — was the topic of a lively debate at the recent European Association for the Study of Diabetes (EASD) 2022 Annual Meeting.

In the debate, the two participants generally agreed that CGM is appropriate for all people with type 1 diabetes and those with type 2 diabetes on intensive insulin regimens.

Most of the discussion centered on people with type 2 diabetes on less intensive treatments and other subgroups.

See article for pro & con positions.

 

[everydayupsanddowns]

Your summary snippet seems broadly in line with recent NICE guidlines.

It is interesting that we have some members not on insulin who have self-funded Libre for a time and found it very helpful to observe and improve their glucose response around foods (which of course is the benefit for insulin users too!).

Like SMBG I think there is benefit for anyone with diabetes who is intending to actively use the data provided to adjust their diabetes management. Little point having CGM if you don’t make ongoing changes / adjustment to your self-management, strategies and approach, both on a short term acute-incident-avoidance and on a longer term overall-tweaking-and-adjusting basis.

 

[Eddy Edson]

Your summary snippet seems broadly in line with recent NICE guidlines.

It is interesting that we have some members not on insulin who have self-funded Libre for a time and found it very helpful to observe and improve their glucose response around foods (which of course is the benefit for insulin users too!).

Like SMBG I think there is benefit for anyone with diabetes who is intending to actively use the data provided to adjust their diabetes management. Little point having CGM if you don’t make ongoing changes / adjustment to your self-management, strategies and approach, both on a short term acute-incident-avoidance and on a longer term overall-tweaking-and-adjusting basis.

OTOH, the con guy made some cogent points:

And now, DeVries pointed out, a study in which the new once-weekly injectable type 2 diabetes agent tirzepatide was added to insulin glargine in patients with type 2 diabetes suggests an alternative to CGM, as this regimen produced a larger drop in A1c (–1.47 vs –0.4 percentage points) along with significant weight loss (–10.5 kg vs no change) and no alarms. "This is not a difficult choice," he commented.

Regarding people with type 2 diabetes not on insulin, DeVries pointed to a study from Japan that showed a significant A1c drop in those using flash glucose monitoring compared with fingerstick monitoring. However, one third of those who were assessed for eligibility declined to participate, and of the remaining 100 patients that were randomized, the between-group difference in A1c was just 0.29 percentage points.

"We have to ask, how meaningful is that difference? I don't think the data are very convincing for patients not on insulin. And that is, of course, the largest group," he noted.

As for people without diabetes or with prediabetes, he pointed out that the market is potentially huge, as long as the device is non-invasive.

Smartwatches are being developed for all kinds of medical assessments, including heart rate, blood pressure, temperature, sleep patterns, gait, and mobility, in addition to glucose and insulin resistance. About 50 million Americans currently use a smartwatch, he noted.

For people without diabetes, use of CGM can reveal how food affects their blood glucose, which might translate to earlier detection of diabetes or prediabetes and perhaps healthier behavior. And in fact, DeVries said that some key opinion leaders in the field are arguing that every healthy person should occasionally use CGM. "There is of course one huge problem. It is that we have no data on this whatsoever."

IMO, the proportion of the total population who would actually benefit from CGM is small, and I doubt that it would actually be very useful for many T2D's not on insulin therapy once they have achieved at least moderate control. But I suppose if the CGM vendors and their spruikers do succeed in getting wide adoption it should push prices down for people who do have a real use for it, and their health systems.

 

[Pumper_Sue]

CGM is def not for everyone with diabetes.
There's a very delightful young man with very special needs who lives in the village, and he becomes very distressed when a sensor is fitted, J is more than happy to have finger pokes but no sensor.