'We Need to Move Forward': CGM in Diabetes

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Hi. Today I am going to discuss the Endocrine Society guidelines^[1] for the use of devices in the treatment of diabetes. I was fortunate enough to be the chairwoman for this committee and it was a wonderful experience, in part because I had such great committee members with whom I worked.

The bottom line of our recommendation was not only that technology is advancing, but that there are tools that should be available to most patients with type 1 diabetes and some patients with type 2 diabetes.

The fundamental premise that we all came to is the true need for patients to have access to continuous glucose monitoring. This is a monitor that is placed on the patient's body for about a week and gives a signal with interstitial blood glucose levels to a receiver (it could be an iPhone or a pump) so that patients can see their blood glucose levels every 5 minutes and see the trends as blood sugar levels rise and fall.

I am at the point where I use these so much with my type 1 diabetes patients that I almost have a problem not having a patient bring me their sensor data. Back in the old days, we used to think that everybody should have finger sticks and bring their finger-stick data in. Now, we must give all of our patients with type 1 diabetes the option of using a continuous sensor because it gives such better data than the static data of finger sticks; you can see the blood sugar levels rise and fall. It really helps patients, whether they are on pumps or multiple daily injections, to make insulin dose adjustments so that they can prevent highs and lows and manage their blood sugar levels much better.

A pump and a sensor is always going to be better than finger sticks and multiple daily injections.

Another committee that I am on is the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) committee on device safety. In that committee, I get to speak with leaders from all over the world to discuss how device development should occur.

One of the problems with devices is that, unlike a new pill for diabetes that requires clinical trials, devices do not have to have lots of clinical trial data in order for them to come to market. It would be nice not only if we got more data from device companies about how often devices fail or how well they work, but also if device companies conducted studies that are true comparisons.

I don't think there is a role anymore for comparing multiple daily insulin injections and finger sticks with any device that is coupled with a sensor, because a pump and a sensor is always going to be better than finger sticks and multiple daily injections. I think we need to move forward, doing real science, comparing people who are on multiple daily injections and a sensor with those on a pump and a sensor that uses some sort of complex algorithm by which the pump then responds to the data from the sensor.

I think we have really moved ahead in terms of what we can now offer our patients. It involves integrating all of the pieces that we have and providing care at all levels.

Using a complex pump sensor system may be beyond the scope of some of our less educated patients, or patients who have not had access to these tools before. We need to develop tools and approaches to treating diabetes that fit people from all walks of life and all levels of education.

I am a real believer in increasing education for all of us—not just endocrinologists, but providers out there who take care of lots of people with diabetes, including nonphysician providers. Education and training for an entire army of nonphysician providers—to go out there and be able to help our patients, train our patients, and help our patients troubleshoot—is very important.

We have the tools now—increasingly complicated and advanced tools for helping our patients—but we need to make sure that patients have access and that we all know what is available and how to use those tools to better help our patients. Thank you.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: 'We Need to Move Forward': Continuous Glucose Monitoring in Diabetes - Medscape - Nov 07, 2016.

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