Continuous Glucose Monitors Continue to Improve Diabetes Care

For patients with diabetes, monitoring blood sugar can be a difficult and painful task. Most of these patients are asked to check their blood sugars multiple times a day and on a regular basis.

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These tests can take a toll on patients, as well as compliance with their therapy plan and on their physical health. Many of these patients may have sore fingers from testing their blood sugars too many times and for so long.

This is why continuous glucose monitors (CGMs) can be life changing, with less finger pokes, improved compliance, and easier use methods. Because diabetic patients need to measure their blood sugars throughout the course of their lives, using CGM devices can make their lives easier on a daily basis. In interviews, many patients have said they appreciate the ease of CGM use and the lack of extra effort.¹

CGMs are devices that allow the patients to automatically measure and estimate blood glucose levels through the day and night. With such devices, patients can review blood glucose level changes over a few hours and be able to look at the trends.

CGMs also allow patients to measure their blood glucose levels in real time and be able to make decisions on what to eat, what to drink, and how much of each. This process helps patients be more proactive in predicting what is coming and to control their blood sugars. This also helps patients stay more motivated and compliant with their medications.¹

Each CGM device has 3 parts. A sensor is inserted under the skin, either on the arm or belly skin, and a small patch holds the sensor in place for the length of its lifetime. Many of these sensors are disposable, but there are also implantable sensors available, which can be placed inside the body. These sensors measure glucose levels in the fluid between the cells, which is similar to the levels in the blood. Depending on the sensor type, they need to replaced every few weeks.¹

The second part of the CGM device is the transmitter, which sends the information collected from the sensor to the third part, which is the receiver. This is mostly done through a wireless system, which can be a specific receiver or via a smartphone that records the glucose values and trends through specific applications.

Some real-time devices measure and show the values on a live basis, whereas others need to be downloaded every few hours to be translated in a trends format. Some also measure the values and allow health care providers to download and to review when the patient returns to the office.

Based on the providers’ recommendations, any patient with type 1 or type 2 diabetes can use these CGM devices, including patients as young as 2 years of age. Many patients depend on their health insurance coverage for these devices, which could limit access.

CGM devices differ based on the sensors they use, how often the sensors need to be replaced, how long it takes for the CGM to warm up, and how easy they are to work with for patients.

There are various types of CGM devices and brands available in the market, including from Abbott, Dexcom, Eversense, and Medtronic. Abbott has the most experience with CGM devices, with FDA approving the first Abbott CGM in 2008.²

Dexcom’s G5 and G6 CGMs are the most used Dexcom devices. The G6 model does not require finger-stick alignment, however, the G5 does still require it. Also, the G6 has a 10-day battery life, versus 7 days for the G5 model. They both have alarms for dangerously high or low levels of glucose and will sound to warn the patient. These devices need new detectors after about 10 days of use, their sensors cannot be reused, and they need a warm-up period for about 2 hours.

Freestyle Libre from Abbott was approved in 2017 and was the first CGM in the market that did not require finger-stick measurements. The Freestyle Libre can keep glucose data for about 90 days, while the sensor can record up to 8 hours.²

The Freestyle Libre has advantages such as replacing the sensor/transmitter every 2 weeks, using a mobile phone as a reader, and data collected by the device can be transferred to other care providers. Libre 2 was launched in 2020 and can be used in adults and pediatric patients 4 years of age and older.²

The Eversense CGM is implanted for 90 days, with a transmitter on the skin that constantly monitors blood glucose levels. The transmitters last for 1 year and the data can be shared with care providers.²

With so many CGM devices available, the future of glucose checking is looking easier and more comfortable for patients. As these devices become more sophisticated and smarter, as well as more affordable, patients will have greater access to CGMs, have many options to choose from, but will be able to remain compliant with their glucose control to achieve their best results in controlling their diabetes.

References

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Website: National Institute of Diabetes and Digestive and Kidney Diseases. Managing Diabetes: Continuous Glucose Monitoring. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring. Accessed September 20, 2023.

2. Aptiva Medical Blog Post: Aptiva Medical. What Are the Different Types of Continuous Glucose Monitoring (CGM) Systems in the United States and How Do I Choose One? Aptiva Medical blog. https://aptivamedical.com/blog/what-are-the-different-types-of-continuous-glucose-monitoring-cgm-systems-in-the-united-states-and-how-do-i-choose-one/. Accessed September 20, 2023.