Changing the Game: Continuous Glucose Monitoring
Diabetes is a big issue in the United States, affecting more than 30 million Americans or close to 10 percent of the population—including 2.8 million Texans—according to the American Diabetes Association (ADA). While most diabetics have Type 2 diabetes, 1.25 million children and adults have Type 1, and the condition affects people of all ages and races, to varying degrees.
The ADA reports that diabetes becomes a personal issue for 1.5 million people and their families each year upon a new diagnosis. It can be overwhelming to navigate the new medical terms, statistics and standards, not to mention the constant blood sugar testing, monitoring and reporting.
The good news is that researchers are working hard to make self-care easier all the time for diabetics, with continuous glucose monitoring (CGM) at the top of that list. A person can monitor his blood sugar 24 hours a day through a sensor that sends blood glucose readings to a monitor, which allows them to set alarms for when levels go too high or too low, so they can make treatment decisions.
Bret Leach, registered nurse and certified diabetes educator at Texas Health Harris Methodist Hospital Southwest Fort Worth, knows a thing or two about the condition and CGM, having been diagnosed with Type 1 diabetes at four years old.
“When you’re testing your blood sugar four times a day with a regular monitor, I compare it to taking photographs of someone jumping up and down,” Leach explains. “Each photo might happen to capture the person mid-jump, so you never see the movement. With continuous glucose monitoring, you get to track trends in real time and see if your levels are rising or falling too fast. I’ve worn a CGM monitor for many years, and it has empowered me because I can see exactly what my blood sugar is doing.”
While blood glucose testing tells a person what his blood sugar level is at that very moment, an A1C test provides an average over a few months, allowing him to get an overall picture of how well he is controlling his diabetes with diet, exercise and/or medication.
Leach says having a more accurate overall picture can help diabetics take better care of themselves.
“When you can look at your overall picture, it can help people with Type 1 and Type 2 reduce their A1C levels by 1.2 to 1.3 percent,” he says. “People used to focus on lowering their A1C, which can lead to hypoglycemia (low blood sugar), but with CGM, you can intervene before that happens.
“I actually started CGM because I had hypoglycemia unawareness, which means my sugar goes really low and I don’t have any symptoms. I totaled two cars and decided I had to do something. After utilizing CGM for several years, I get hypoglycemia a lot less and actually have symptoms again, because my body isn’t used to my sugar being too low all the time.”
CGM is more commonly used for Type 1 diabetics and is prescribed by physicians for both adults and children as young as two years old. Leach explains that since Type 1 diabetics don’t make any insulin, there is a lot more variability in their blood sugar ranges, making constant monitoring that much more beneficial. Most Type 2 diabetics are still making some insulin, so there is a lot less variability.
While CGM devices must be prescribed by a physician, insurance coverage has been an issue. A patient must meet certain criteria to qualify, such as being on intensive insulin therapy, but Leach says Medicare has started approving CGM technology in recent years. The encouraging news is that the potential of continuous glucose monitoring is increasingly becoming more known, as evidenced by a scientific statement released in October 2017 by the American Diabetes Association.
Leach says CGM can bring peace of mind to both diabetics and their caregivers, especially parents of young children with the condition.
“Parents of kids with CGM are having great luck with it because they can monitor their child’s blood sugar during naps and at night, as well as when they are at school,” he explains. “We recently did an education program for school nurses about how to care for kids with diabetes, and they say many of their students are utilizing CGM.
“It’s a huge weight off your shoulders and your family’s when you can share your information about what your blood sugar is doing. I personally had huge issues with my levels during the night when I was sleeping, so it’s great to be able to set alarms that will notify someone else if you’re having trouble. It’s a great tool and is really empowering.”
Leach explains that while some people get overwhelmed by the wealth of information CGM provides, the technology has the potential to help a diabetic get a better handle on their health, which is the goal at the end of the day.
“CGM allows us to see how everything affects our blood sugar … different foods, exercise and other activities, sleep and medications,” he says. “If you can make the technology work for you, it really helps manage things. You can see that you’re going low and suspend the scheduled insulin delivery. But if someone is struggling to control things and their alarms are going off constantly, it can be overwhelming. Some people will just start disregarding the alarms, which defeats the whole purpose.
“Automation is the frontier and the new hybrid closed-loop systems deliver basal insulin based on CGM readings without the person even having to intervene. Someday we won’t have to do finger sticks at all, and self-monitoring will be eliminated. CGM technology has the potential to be a real game changer for so many people.”
For more information about diabetes, Texas Health’s diabetes outpatient centers and to take a diabetes risk assessment visit TexasHealth.org/Diabetes