Mobile Technology And Decision Support
It has become increasingly clear that the isolated use of glucose monitoring technologies without a plan for using the data provides minimal benefit, particularly among patients with type 2 diabetes or who are not using insulin . In order for glucose monitoring to provide the most benefit, patients and providers must be able to easily obtain and communicate the data. Data must be organized in such a way that patterns can be identified, and patients must receive feedback at the point of care. The widespread use of mobile devices provides opportunities for data collection, analysis, and communication of results with health care providers as well as facilitates digital or remote clinical models of care . Finally, as healthcare providers are inundated with more data and spend increasing amounts of time using electronic medical records, it has also become paramount that devices and or reports from the devices communicate or interface with these systems .
The Best Glucose Monitors
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People living with diabetes should check their blood sugar regularly. There are currently two main options for monitoring glucose levels continuous glucose monitoring devices and blood glucose meters. The best monitors give reliable, consistent readings to help guide a persons treatment.
- Best for continual measurement from a below-skin sensor: Dexcom G6 CGM System
- Best for predictive glucose spike warnings: The-Guardian-Connect-System
- Best for glucose alarms: FreeStyle-Libre-2-System
- Best for tracking and sharing with medical professionals: Contour Next One
- Best monthly digital subscription: OneDrop Glucose Meter
Please note that the writer of this article has not tried these products. All information presented is purely research-based.
There are two types of glucose monitors:
- continuous glucose monitor
- blood glucose meter
Both types of monitors have different characteristics, benefits, and drawbacks that a person with diabetes should consider.
Both CGM and BGM monitors require a prescription.
Who Are They Useful For
CGMs can help people with diabetes monitor and maintain their blood glucose levels. While they do not involve finger pricking, they may be useful for calibrating the device.
Earlobe, breath, and other noninvasive devices may be beneficial for monitoring blood glucose levels, especially in children with the same condition and those who have cystic fibrosis. However, they are not FDA-approved, and some may need further testing to determine their safety and accuracy.
To learn more about diabetes and how to monitor and manage the condition, visit our dedicated hub.
MNT chooses at-home tests that meet the following criteria:
- Budget: MNT chooses products that suit a wide range of budgets.
- FDA approval: MNT chooses products that have been cleared or approved by the FDA.
- Smartphone compatibility:MNT selects products that are easily connected to smart devices and provide regular readings via an app.
Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.
Medical News Today follows a strict product selection and vetting process. Learn more here.
Below are four blood sugar monitors that do not require finger pricks.
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How We Chose Glucose Monitors And Meters
Above all, we included glucose monitors that are reportedly the most accurate. Since home meters are designed to help you monitor your glucose in between laboratory work from your doctors visits, its important that your device provides the most accurate results possible.
While no home test will be as accurate as a lab version, getting as close as possible to the quality of such tests can help provide peace of mind as well as better diabetes management.
Other items we looked at include:
We included glucose meters across a variety of features and price points. The cost of CGMs and blood glucose meters can vary widely based on their features, your insurance coverage, and location. Cost is also subject to change over time based on the type of insurance you have, so be sure to check with your carrier for the most accurate price.
Implementing Inpatient Continuous Glucose Monitor Use During Covid
Jennifer LaPreze, PharmD, BCACP, CDCES, CPPClinical Staff PharmacistAmanda Woods, PharmD, BCACP, CDCES, CPPClinical Pharmacist CoordinatorConcord, North Carolina
US Pharm. 2020 45:HS1-HS8.
ABSTRACT: Incidences of hyperglycemia and ketoacidosis are higher in patients with diabetes who have coronavirus disease 2019. Frequent glucose monitoring in these patients increases the exposure risk for healthcare workers and requires the use of limited supplies of personal protective equipment. In April 2020, the FDA stated that it would not object to the use of continuous glucose monitoring devices in the inpatient setting during the pandemic. CGM use enables real-time glucose monitoring and minimizes frequent finger-stick testing, providing an opportunity to use a new method of diabetes management in the inpatient setting. Ongoing research and FDA clearance are necessary before CGM implementation in the hospital setting can become widespread.
Also Check: The American Diabetes Association Website
The Guardian Connect System
For predictive glucose spike warnings
The Guardian Connect System from Medtronic is a CGM that predicts potential spikes in glucose levels and sends warning alerts accordingly. The company offers features such as:
- a 30-day free trial
- rechargeable transmitter
- app for both Android and iOS devices
Medtronic is working with over 600 insurance companies to make the device financially accessible to a broader group of people.
Individuals can register for a 30-day free trial by completing a form on the companys website.
What To Look For
If youve used a traditional glucose monitor in the past and are looking for a less painful, more portable option, then a CGM may be a better choice. You may consider the Libre, G6, Guardian Connect, or Eversense based on their features, as well the accuracy and duration of sensor wear.
While insurance and Medicare do cover CGMs, these monitors are more expensive overall. Depending on your insurance, they may offer coverage for one type of CGM but not another. Its important to check these details with your provider ahead of time.
If you dont have insurance, you can check with your doctor or pharmacist for discounts on your CGM and accessories. Its also possible to get coupons directly from the manufacturer to help offset the costs.
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Continuous Glucose Monitoring Systems For Diabetics
Monday, February 24, 2020
Continuous glucose monitoring systems allow for ongoing, real-time monitoring and recording of blood glucose levels at set intervals, which can be helpful for diabetic patients who need to closely track their blood glucose levels. Retroactive to Jan. 1, 2020, TRICARE has revised its CGMS benefit to allow for the use of U.S. Food and Drug Administration -approved CGMSs by beneficiaries with uncontrolled diabetes. The device must be ordered by a TRICARE-authorized provider and the beneficiary must meet all coverage criteria.
TRICARE will cover therapeutic and non-therapeutic devices however, therapeutic and non-therapeutic devices and supplies may not be billed on the same claim. Please bill per month rather than every 30 days. This will help reduce claim rejection errors for non-30-day months. Refer to TRICARE Policy Manual, Chapter 8, Section 5.3, paragraph 6.0 for specific billing guidelines.
Durable medical equipment prior authorization rules apply. If an approval is not required, you must submit documentation with the claim showing the beneficiary meets all coverage criteria. To expedite the review process, we offer a Letter of Attestation that can be attached in lieu of clinical documentation on our Letters of Attestation page.
TRICARE offers CGMS coverage for TRICARE beneficiaries who:
Cgm Makes Testing Easy
Using a blood glucose monitor requires multiple fingersticks a day to monitor blood sugar levels. With continuous glucose monitors, the sensor measures the interstitial fluid multiple times per hour, providing about 288 readings per day. Additionally the CGM provides reporting that makes it easy to track high and low trends and share readings with loved ones and caregivers.
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Analysis Of Retrospective Data
Data from all CGM devices can be studied retrospectively after downloading . It is recommended that diet, activity, symptom, and insulin data are collected during professional CGM to assist with interpretation, either via patient diary, direct entry of events into the device, or use of an accompanying app, depending on the system. Three time periods should be analyzed. These are:
- Overnight: Out-of-target overnight glucose levels can be modified by adjusting the basal insulin dose.
- Pre-prandial Period: Out-of-target pre-prandial glucose levels can be modified by adjusting the previous meal bolus, meal, or exercise pattern.
- Post-prandial period: Out-of-target postprandial glucose levels can be modified by adjusting the immediate meal bolus, meal, or exercise pattern.
In certain special situations, targets may need to be adjusted. Other important elements of a professional CGM analysis are shown in . An example of a patient who used CGM is presented in . The CGM demonstrated high glucose levels from 6:00 PM to 11:00 PM post-supper and low glucose levels from 12:00 AM to 2AM. Recognition of these patterns allowed appropriately timed treatment interventions.
What Cgms Are Available In The Us
Currently, four companies have personal CGM devices on the US market: Abbott , Dexcom , Medtronic , and Senseonics Eversense. The table below compares some of their key features. Pricing varies with insurance coverage and can be provided by the company. For people paying out-of-pocket , FreeStyle Libre is the least expensive CGM as of this writing.
Also Check: What Problems Can Diabetes Cause
Who Can Use A Cgm
Most people who use CGMs have type 1 diabetes. Research is underway to learn how CGMs might help people with type 2 diabetes.
CGMs are approved for use by adults and children with a doctors prescription. Some models may be used for children as young as age 2. Your doctor may recommend a CGM if you or your child:
- are on intensive insulin therapy, also called tight blood sugar control
- have hypoglycemia unawareness
- often have high or low blood glucose
Your doctor may suggest using a CGM system all the time or only for a few days to help adjust your diabetes care plan.
Where Can I Test My Blood Sugar Besides My Finger
The finger is the most reliable area for a person to test their blood sugar. However, some monitors may allow for alternate site testing. These alternate sites may include the palm, upper forearm, abdomen, calf, and thigh.
A person should always check the instructions on their blood glucose monitor to check if this is possible before performing alternate site testing.
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Special Features Of A Cgm
CGMs are always on and recording glucose levelswhether youre showering, working, exercising, or sleeping. Many CGMs have special features that work with information from your glucose readings:
- An alarm can sound when your glucose level goes too low or too high.
- You can note your meals, physical activity, and medicines in a CGM device, too, alongside your glucose levels.
- You can download data to a computer or smart device to more easily see your glucose trends.
Some models can send information right away to a second persons smartphoneperhaps a parent, partner, or caregiver. For example, if a childs glucose drops dangerously low overnight, the CGM could be set to wake a parent in the next room.
Currently, one CGM model is approved for treatment decisions, the Dexcom G5 Mobile. That means you can make changes to your diabetes care plan based on CGM results alone. With other models, you must first confirm a CGM reading with a finger-stick blood glucose test before you take insulin or treat hypoglycemia.
Comparison To Other Devices
The FreeStyle Libre is referred to as a flash glucose monitoring system. Unlike other CGMs, like the Medtronic Guardian 3 and Dexcom G6, the FreeStyle Libre checks glucose levels every minute rather than every five minutes. It can also be worn for 14 days as opposed to seven days for the Medtronic Guardian 3 or 10 days for the Dexcom G6.
The FreeStyle Libre system does not require fingerprick calibrations. And, because there is no transmitter, the system costs less than other CGMs.
Whereas other CGM sensors can be placed on the belly and buttocks, the FreeStyle Libre is only approved for use on the back of the arm. If placed in other areas, the sensor may not work properly.
A newer CGM called the Eversense system offers continuous 90-day glucose monitoring. But sales of the device were halted in 2020 due in part to the COVID-19 pandemic but also to the fact that the device has to be implanted by a doctor.
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Why Should You Buy Continuous Glucose Monitors From Ads
Some might still ask why they should buy continuous glucose monitors from us. With ADS, you are assured of the best accreditations within the field of diabetes supply.
Moreover, we take care to give you the best possible customer service at every point. Our customer care representatives are trained to care about our valued customers. For any questions regarding CGM products and therapies, please call us at , or contact our Customer Care Team.
Special Requirements Needed To Use A Cgm
Twice a day, you may need to check the CGM itself. Youll test a drop of blood on a standard glucose meter. The glucose reading should be similar on both devices.
Youll also need to replace the CGM sensor every 3 to 7 days, depending on the model.
For safety its important to take action when a CGM alarm sounds about high or low blood glucose. You should follow your treatment plan to bring your glucose into the target range, or get help.
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Other Meters Being Developed
Besides the above four CGMs, other meters are being developed that do not require blood samples. One such CGM is called GlucoTrack by Integrity Applications, which measures blood glucose via your earlobe. However, it hasnt yet been FDA approved.
Other types of technologies may be seen soon to help improve diabetes management without the need for finger pricks. However, standalone smartwatches, contact lenses, and other buzzworthy devices havent yet proven to accurately measure blood glucose.
What Do Cgms Do
Continuous glucose monitors measure the bodys glucose levels in real-time by sensing the glucose present in tissue fluid . Glucose is another word for sugar. While a blood glucose meter provides a measurement of the blood glucose level at a specific moment in time , CGMs typically provide a new glucose level every five minutes, meaning 288 times per day. A BGM is similar to a photo providing a single blood sugar snap shot while a CGM is like a video, providing a constant stream of information on glucose levels, trends, and overnight data.
CGMs are particularly useful after meals and overnight, as they can sound an alert when glucose levels drop or rise below a preset threshold. CGMs provide a good way to monitor time spent in range for more on time-in-range goals, see here and here.
Some CGMs need to be calibrated with a fingerstick blood sugar reading for optimal sensor accuracy two CGMs currently do not need fingerstick calibrations Abbott’s FreeStyle Libre and Dexcoms G6.
Also Check: How Many Calories Can A Diabetic Have Per Day
How Do Cgms Work
Its easy to use a CGM. You just insert a small sensor under the skin by using a simple applicator. The sensor is held in place by adhesive tape. This allows the sensor to measure glucose readings in the interstitial fluid, which is fluid that surrounds the cells. It takes the readings throughout the day and night.
A transmitter, which is connected to the sensor, causes the system to send real-time readings wirelessly to either a monitoring device or an app on your smartphone that displays your glucose data.
Important Update: August 10 2020
Senseonics announces agreement to collaborate with Ascensia Diabetes Care
Today we announced the signing of a collaboration and commercialization agreement between Senseonics, Incorporated, maker of the Eversense® brand of continuous glucose monitoring systems, and Ascensia Diabetes Care , maker of the CONTOUR® portfolio of blood glucose monitoring systems. This collaboration will help more people living with diabetes gain access to the Eversense CGM technology, with Ascensia taking responsibility for sales, marketing, and distribution of Eversense products in the US, effective in 2021. In advance of this date, Ascensia will begin to work alongside us on initial sales and marketing activities in 2020.
We are excited to be partnering with Ascensia, a global diabetes technology company that is a leader in the blood glucose monitoring market. Ascensia has a legacy of almost 80 years in diabetes care and shares the same passion and commitment to delivering highly accurate and state-of-the-art products for people with diabetes. We will continue providing the Eversense CGM system you have come to trust and rely on, as the only long term CGM system in the world. Going forward, Senseonics will continue to innovate our technology, including bringing advanced Eversense products with extended-life sensors to the US market upon FDA approval.
Francine Kaufman, MD and the Senseonics Leadership Team
To read the press release, .
To learn more about Ascensia Diabetes Care, .
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Covid19 Impact: High Usage In Isolated Patients The Market Increased By 18% In 2020 From 2019
Post COVID Outlook
Due to the need for remote monitoring of COVID-19 patients, the CGM has shown sudden demand growth during COVID-19
Studies suggest that the average time-in-range of the CGM users increased faster during the pandemic. The trends are expected to significantly impact the adoption of CGM in upcoming years.
The demand for continuous monitoring of COVID-19 patients, in both, hospital and home settings was significant during the pandemic.
As COVID-19 recovered diabetes patients develop resistance to insulin, the traditional injections fail to provide proper management. CGM can replace the need for frequent sugar level checks.
Obesity is a major factor leading to diabetes. According to WHO, in 2016, over 1.9 billion adults were overweight, of which, around 650 million people were obese. These devices allow the observation of blood glucose at various time intervals with the help of a sensor and these readings are transmitted over a wireless network. Respective readings are fed into diabetes management software to allow the patient to understand the disease better, in turn, helping them to manage it better.