In Study Dexcom Finds Cgms Can Benefit Type 2 Patients Too
A new study published today in Annals of Internal Medicine and sponsored by Dexcom shows that a continuous glucose monitor could lower the HbA1c scores of people with Type 2 diabetes, and that acceptance of the technology is high among that group as well.
Right now, continuous glucose monitoring is a technology mostly used by people with Type 1 diabetes, many of whom administer insulin via an automated pump. But people with Type 1 diabetes make up just 5 to 10 percent of people with diabetes in the US, according to the CDC. The others have Type 2 diabetes and often administer insulin via multiple daily injections .
We have been successful in driving innovation and adoption of CGM in the Type 1 diabetes community, but this arm of the DIaMonD study is one of the first to examine how well CGM works for people with Type 2 diabetes on MDI, Kevin Sayer, president and CEO of Dexcom, said in a statement. We are pleased to see a significant A1C reduction in this study, showing that the millions of people globally with Type 2 diabetes on MDI insulin therapy can benefit from CGM use.
On its earnings calls to investors, Sayer has made no secret about Dexcoms aspirations to widen its total addressable market by eventually marketing its CGMs to people with Type 2 diabetes. This study is the first step in clinically validating that approach.
Furthermore, CGM users were adherent to the device and overwhelmingly rated the benefits of the technology as high and the hassles as low.
Which Other Devices Does Dexcom G6 Work With
When the FDA approved the G6 in 2018, the agency created a brand-new category of device that it refers to as iCGM, or Integrated CGM a system designed to connect directly with other compatible devices, such as a smartphone, insulin pump, or other wearable.
Devices that currently work the Dexcom G6 include the latest Omnipod tubeless insulin pump, as well as the tubed Tandem t:slim X2 insulin pump with Basal-IQ and Control-IQ closed loop features. Not sure whether your device is compatible with Dexcom G6? You can check that out here.
Whats exciting is that the future Dexcom G7 model will have even more advanced features, and integration with automated diabetes management systems.
How Does A Continuous Glucose Monitor Work
A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.
The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. Several models are available and are listed in the American Diabetes Associations product guide.
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Cgm & Time In Range
Continuous glucose monitors , as the name suggests, continually monitor the glucose in your blood through an external device thats attached to your body, and gives real-time updates. Theyve become popular and more accurate over the years, and with that improvement has come a new way to manage your blood sugarenter time in range .
Integration With Other Systems
The G6 is already a leader in system interoperability, and is the only product that has been approved for use with hybrid closed-loop insulin delivery systems. All of those relationships will remain in place with the G7. It will also integrate with the Apple Watch. In addition to integration with the Tandems Control IQ and Insulets OmniPod system, integration has also been developed for Companion Medicals InPen as well as over 25 commercially-available apps. This is a fast-changing landscape, but Dexcom has always been ahead of the curve in securing relationships with other smart diabetes device makers.
The G7 will be compatible with both Android and iOS smartphones, and will also work with a receiver for those patients who prefer not to use a smartphone to track their blood sugar.
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Who Should Use Cgm
Patient selection is a key component of successful CGM use. The Endocrine Society recommends CGM for adults with type 1 diabetes who have A1C levels above 7% and who have shown they can use these devices nearly every day. Some devices are also approved for children over age 2 with a healthcare provider’s prescription.
It’s crucial to understand CGM technology in order to reap the maximum benefit. The intermittent use of CGM may be appropriate for people with overnight hypoglycemia or hypoglycemic unawarenessan inability to recognize the signs of dips in blood sugar levels that can be dangerous if not dealt with immediately.
It may also be beneficial for people who are on tight blood sugar control, also known as intensive insulin therapy.
How Can I Save On A Continuous Glucose Monitor
Currently, Dexcom has a copay savings program for people with commercial insurance that can take up to $10 off the receiver, $70 off a transmitter, or $70 off a months worth of sensors. Theres also a free trial for the Dexcom G6 for 10 days through their Hello Dexcom program if you use insulin and have a sample kit from your provider.
If you dont have insurance, GoodRx can save you about 17%, bringing the cost to around $300 for a transmitter and $350 for a months supply of sensors.
Abbott offers a free 14-day trial of both the Libre 14 Day and Libre 2 with the MyFreeStyle program. If you qualify for this, youll receive either one free sensor of the Libre 14 Day system or one free sensor and the reader for the Libre 2 system.
With GoodRx, you can save between 11% and 18%, bringing the cost to around $76 for the Libre 14 Day reader and $110 for 28 days worth of sensors for both FreeStyle models.
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The Dexcom G6 Continuous Glucose Monitoring System
Amy Renaud, PharmDCollege of Pharmacy & Pharmaceutical SciencesTallahassee, Florida
Associate Professor of Pharmacy PracticeFlorida A& M UniversityCollege of Pharmacy & Pharmaceutical SciencesTallahassee, Florida
Ukamaka Dike Smith, PharmD, MBAAssistant Professor of Pharmacy PracticeFlorida A& M UniversityCollege of Pharmacy & Pharmaceutical SciencesTallahassee, Florida
Associate Dean and Associate Professor of Pharmacy PracticeFlorida A& M UniversityCollege of Pharmacy & Pharmaceutical SciencesCrestview, Florida
Assistant Professor of Pharmacy PracticeFlorida A& M UniversityCollege of Pharmacy & Pharmaceutical SciencesCrestview, Florida
Executive Associate Dean and Professor of Pharmacy PracticeFlorida A& M UniversityCollege of Pharmacy & Pharmaceutical SciencesTallahassee, Florida
US Pharm
Diabetes is a condition that can affect adults and children and may lead to complications such as nephropathy, retinopathy, peripheral neuropathy, and atherosclerotic cardiovascular disease.1 Approximately 8.2% of the United States population was diagnosed with diabetes in 2018. Based on data collected from 2013 through 2016, 50% of U.S. adults with diabetes had a hemoglobin A1C > 7%. According to 2018 data, insulin therapy was initiated in approximately 10.9% of U.S. adults within 1 year of being diagnosed with diabetes. Populations with prevalence rates of > 10% in the United States include Native Americans, Hispanic Americans, and African Americans.2
The Guardian Connect System
The Guardian Connect System is a CGM that can tell you your current glucose readings quickly via a connected app and also lets you easily access trends and data about your blood sugar over time. One feature that stands out with The Guardian is the “predictive” alerts you can get about your sugar. Unlike other CGM systems that alert you when your sugar is already high or low, The Guardian uses technology that predicts when your blood sugar might get high or low, before it happens. Another feature that comes with the monitor is the Sugar.IQ diabetes assistant app for diabetes management, which uses your data to help you figure out what diet, exercise and insulin works best for you.
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Brand Overview And Reputation
Founded in 1999, Dexcom released its first continuous glucose monitor in 2006. The company has since made changes and upgrades to its designs. The Food and Drug Administration and Medicare have approved the system and devices for various uses.
Dexcom claims their system can continuously provide updates and feedback about a persons blood sugar levels. The person can then use the information to help manage their diabetes.
A person will require a prescription from their doctor.
Though Dexcom highlights positive reviews from several influencers on their website, all are paid spokespersons.
Trustpilot ratings suggest the brand has a poor reputation. Out of over 30 reviews, they currently have a rating of 2 out of 5 stars. Reviewers mainly complain about poor customer service. Several also mention that the sensors are inaccurate and need constant calibration.
The Better Business Bureau has a similar response from users. Out of over 140 reviews, they have a rating of 1.1 out of 5 stars. The reviews on BBB also mention poor service and inaccurate readings. The company has closed over 160 complaints in the past 3 years.
Dexcoms CGM system pairs with companion apps to display data in real-time. Their products and services include:
Tom Mcconnell 60 Years Old
Ive had type 2 diabetes for 21 years, says Tom McConnell. Ive only used a Dexcom CGM for about four years.
McConnell says he was very reluctant to start using it, for the same reason many are: he didnt like the idea of having something stuck on him all the time.
But now that its on me, I never notice it, and I use the information from it a lot, he adds. I did not realize just how often I would want to pick up the receiver and see what my number is at. Now Im constantly aware of my number.
McConnell says he most appreciates the way it lets you know if youre rising or falling.
I feel like I have so much more control over my blood sugars since I got it, he adds. I look at it every half hour, especially when Im trying to decide whether to eat or what to eat. I know how much insulin to take based on all the information I get from this thing.
For example, explains McConnell, his blood sugar was high the other night after dinner, before heading to bed. He could see it was only heading higher.
So I took extra insulin to correct the high, and I woke up this morning at 97 mg/dL. Without it, I wouldve been high all night.
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How Much Does It Cost
Dexcom CGMs are covered by a large array of private insurers in the United States. As of fall 2020, Medicare does cover the Dexcom G6, as well.
Of course, benefits vary by plan, so youll need to check with yours. Just remember that youll need a prescription for the G6 transmitter as well as the box of sensors, so youll have to work with a healthcare professional before purchasing.
Until spring 2021, Dexcom sold their systems and supplies directly via their website. But they now work with distributors like Edgepark for online ordering.
Short answer: The Dexcom G6 is a great tool for any adult or child with any type of diabetes, including those who are pregnant or diagnosed with gestational diabetes, given how important tight glucose management is during pregnancy.
The benefits of CGM use are well-documented:
- helps avoid severe high or low blood sugars, especially immediately dangerous hypoglycemic events
- helps guide insulin dosing and safeguard users from suffering mistakes
- sense of safety and security for those who dont feel dangerous lows coming on
- increased glucose time in range for better diabetes control
- lets users see and learn from the direct impact of their food and physical activity on their body
In fact, CGM is so powerful for improving overall health outcomes that its quickly becoming a consumer wellness product.
Theres little doubt that all people with diabetes can benefit, but
What Happens If My Blood Sugar Is Out Of Range
Some CGMs can also alert you if your sugar is too high or too low. Its important to know that not all devices have this alert system. If this function is available, your reader or phone will either make a noise or vibrate to let you know you are out of your goal range.
But even if your CGM isnt alerting you of changes, you should always double-check your blood sugar with a traditional finger stick meter if you are having symptoms of high or low blood sugar.
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How Does A Cgm Compare To A Blood Glucose Monitor
There are several differences between CGMs and traditional blood glucose monitors . The biggest selling point for CGMs is the ability to say goodbye to uncomfortable finger pricks every day, as the sensors are painless to apply and can stay in place for several days or weeks, depending on the model you have.
Click here for more information on how BGMs differ from CGMs and how to decide which is the best choice for you.
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.
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Costs And Health State Utilities
A utility benefit was applied to the RT-CGM arm owing to the combined benefits to QoL associated with a reduced fear of hypoglycemia and avoidance of fingerstick testing with the Dexcom G6 RT-CGM system. In the DIAMOND trial FoH was measured using the worry subscale of the Hypoglycemia Fear Survey. The mean difference in FoH score between the treatment arms was 3.17 units, with patients in the RT-CGM having less FoH. This benefit was converted to a utility benefit of 0.02536 based on a previously published mapping to the EQ-5D by Currie et al. Similarly, a 0.03 utility benefit was also applied owing to the avoidance of fingerstick testing, based on the findings of a study comparing flash glucose monitoring with SMBG as this method of glucose monitoring also reduces or negates the requirement for fingerstick testing. This resulted in a total utility benefit of 0.05536 applied to the arm using the Dexcom G6 RT-CGM system .
For patients with no complications, a utility value of 0.90 was assumed, based on findings of the DIAMOND trial. Disutilities associated with long-term diabetes-related complications and hypoglycemic events were sourced from the literature .,
Competition In Type 2 Diabetes Heats Up With Dexcom Data
Last week Dexcom, a Wall Street darling that dominates diabetes continuous glucose monitoring , just put another feather in its own cap with the release of new clinical data.
The existing Dexcom CGM device in the market called G6 has been a real advance for patients. It was the first CGM to gain FDA approval for use with electronic devices used to manage diabetes such as automated insulin dosing systems and insulin pumps.
Despite the relatively recent 2018 FDA approval for the G6, the market has been eagerly awaiting news of the release of Dexcoms fully redesigned G7 CGM device which is 60% smaller than the G6, has a faster warm-up time, more open-source connectivity with various insulin delivery systems and an upgraded app experience.
Last week, at the International Conference on Advanced Technologies & Treatments for Diabetes , Dexcom announced the publication of two new studies that support the G7 and the efficacy of CGM for type 2 diabetics.
1) The MOBILE study, just published by JAMA, is a randomized, controlled study showing people with Type 2 diabetes using background insulin benefitting from CGM when compared to a traditional blood glucose meter. The device used in the study was Dexcoms G6 and patients in the CGM arm showed improved hemoglobin A1c, nearly four more hours each day within an optimal glucose range and experienced fewer periods of low blood sugar.
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Is Dexcom G6 Covered By Insurance
CGM doesnt come cheap. In general, health insurance is more likely to pick up the tab for CGM for someone who has Type 1 diabetes. The good news is that more and more people who have Type 2 diabetes are getting coverage. Youre more likely to get insurance coverage if you have high blood sugar , frequent episodes of low blood sugars, or hypoglycemia unawareness.
Charles Costello 50 Years Old
Ive lived with type 2 diabetes for 10 years, and using a Dexcom on and off for the last two years, says Costello.
At first, Costello wasnt committed to wearing it all the time. But after several severe low blood sugarsincluding a recent event that required a call to 911Costello realized the amount of safety it provided him.
I took my mealtime Novolog insulin and then I got distracted and didnt eat right away, explains Costello. I dropped extremely low, down to 22 mg/dL. If I was wearing my CGM, that wouldnt have happened. I wouldve gotten an alert at 80 mg/dL and remembered to eat.
His current insulin regimen involves taking Tresiba twice a day. At every meal, he takes a set dose of Novolog, regardless of what he eats.
Costello also finds it helpful for knowing what to eat, or for looking back on how he reacted to a certain meal.
If Im below 80 mg/dL, I know I need some orange juice. If Im over 200 mg/dL after eating, I know I shouldnt have eaten as much or I had too many carbs.
Having a set dosage for his meals means he can also experience lows after eatingif his dinner was lower in carbs.
For his wife, Costello says using a CGM has taken a lot of worry off her mind.
My wife worries about me constantly because of those bad lows, explains Costello. Knowing that I have this to alert me when I go below 80 mg/dL really relieves the burden on her.
Curious about using a CGM? Read more about CGMs and Type 2 diabetes.
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