In the national fight against the diabetes epidemic, the necessary weapon that is actively promoted to patients is only one-quarter small and can be worn on the abdomen or arm.
Continuous blood glucose monitors are equipped with a tiny sensor that fits just under the skin, reducing the need for patients to prick their fingers every day to check blood glucose. The monitor keeps track of the glucose level, sends the reading to the patient’s mobile phone and doctor, and alerts the patient when the reading is too high or too low.
According to data from the investment company Baird, nearly 2 million people have diabetes today, which is twice the number in 2019.
There is little evidence that continuous blood glucose monitoring (CGM) has a better treatment effect for most diabetic patients-health experts say that an estimated 25 million people with type 2 disease in the United States do not have insulin injections to regulate their blood sugar. However, the manufacturer, as well as some doctors and insurance companies, said that compared to a daily fingertip test, the device helps patients control diabetes by providing near-instant feedback to change diet and exercise. They say this can reduce the costly complications of diseases, such as heart attacks and strokes.
Dr. Silvio Inzucchi, director of the Yale Diabetes Center, said that continuous blood glucose monitors are not cost-effective for patients with type 2 diabetes who do not use insulin.
He said that it is certain that popping the device out of the arm once every two weeks is much easier than having multiple finger sticks that cost less than $1 a day. But “for ordinary type 2 diabetic patients, the price of these devices is unreasonable and cannot be used routinely.”
Without insurance, the annual cost of using a continuous blood glucose monitor is between nearly $1,000 and $3,000.
People with type 1 diabetes (not producing insulin) need frequent data from the monitor in order to inject appropriate doses of synthetic hormones through a pump or syringe. Because insulin injections can cause a life-threatening blood sugar drop, these devices also warn patients when this happens, especially during sleep.
Patients with type 2 diabetes who have another disease do make insulin to control the rise in blood sugar after eating, but their bodies do not respond strongly to people without the disease. About 20% of type 2 patients are still injecting insulin because their bodies cannot get enough nutrients and oral medications cannot control their diabetes.
Doctors usually advise diabetics to test their glucose at home to track whether they are reaching treatment goals and to understand how medication, diet, exercise, and stress affect blood sugar levels.
However, an important blood test that doctors use to monitor diabetes in patients with type 2 disease is called hemoglobin A1c, which can measure average blood sugar levels for a long time. Neither the fingertip test nor the blood glucose monitor will look at A1c. Since this test involves a large amount of blood, it cannot be performed in a laboratory.
Continuous blood glucose monitors also do not evaluate blood glucose. Instead, they measured glucose levels between tissues, which are the sugar levels found in the fluid between cells.
The company seems determined to sell the monitor to type 2 diabetic patients (both people who inject insulin and people who do not) because this is a market of more than 30 million people. In contrast, about 1.6 million people have type 1 diabetes.
Falling prices have been boosting the growth in demand for displays. Abbott’s FreeStyle Libre is one of the leading and lowest-priced brands. The device is priced at US$70 and the sensor costs approximately US$75 per month, which must be replaced every two weeks.
Almost all insurance companies provide continuous blood glucose monitors for people with type 1 diabetes, which is an effective life-saving straw for them. According to Baird, nearly half of people with type 1 diabetes now use monitors.
A small but growing number of insurance companies have begun to provide medical insurance for some type 2 patients who do not use insulin, including UnitedHealthcare and Maryland-based CareFirst BlueCross BlueShield. These insurance companies said they have achieved initial success in the use of monitors and health coaches to help control their diabetes members.
One of the few studies (mostly paid for by the equipment manufacturer, and at a low cost) has studied the impact of monitors on the health of patients, and the results have shown conflicting results in reducing hemoglobin A1c.
Inzucchi said that despite this, the monitor helped some of his patients who don’t need insulin and don’t like piercing their fingers to change their diets and lower their blood sugar levels. Doctors said they have no evidence that the readings can make lasting changes in patients’ eating and exercise habits. They say that many patients who do not use insulin are better off attending diabetes education classes, attending gyms or seeing a nutritionist.
Dr. Katrina Donahue, research director of the Department of Family Medicine at the University of North Carolina, said: “Based on our available evidence, I believe that CGM has no additional value in this population.” “I’m not sure for most patients. , Whether more technology is the right answer.”
Donahue is the co-author of a landmark study in JAMA Internal Medicine in 2017. The study showed that a year later, a fingertip test to regularly check the blood glucose level of patients with type 2 diabetes is not beneficial for lowering hemoglobin A1c.
She believes that, in the long run, these measurements have not changed the patient’s diet and exercise habits-the same may be true for continuous blood glucose monitors.
Veronica Brady, a diabetes education expert at the University of Texas Health Sciences Center and spokesperson for the Association of Diabetes Care and Education Experts, said: “We must be careful about how to use CGM.” She said if people These monitors make sense for a few weeks when changing medications that may affect blood sugar levels, or for those who do not have enough capacity to perform fingertip tests.
However, some patients like Trevis Hall believe that the monitor can help them control their disease.
Last year, as part of a plan to help control his diabetes, Hall’s health plan “United Healthcare” provided him with monitors for free. He said that connecting the monitor to the abdomen twice a month will not cause discomfort.
Data show that Hall, 53, from Fort Washington, Maryland, said his glucose will reach dangerous levels a day. He said of the alarm that the device will send to the phone: “It was shocking at first.”
Over the past few months, these readings have helped him change his diet and exercise patterns to prevent these spikes and control the disease. These days, this means walking quickly after a meal or eating vegetables at dinner.
These manufacturers have spent millions of dollars to urge doctors to prescribe continuous blood glucose monitors, and they advertised patients directly in Internet and TV commercials, including in this year’s Super Bowl by singer Nick Jonas (Nick Jonas). Jonas) starring in live commercials.
Kevin Sayer, CEO of Dexcom, one of the leading manufacturers of displays, told analysts last year that the non-insulin type 2 market is the future. “Our team often tells me that when this market develops, it will explode. It will not be small, and it will not be slow,” he said.
He added: “I personally think that patients will always use it at the right price and the right solution.”
Post time: Mar-15-2021