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Simple steps can improve experience, avoid frustrations with CGM
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INDIANAPOLIS — Continuous glucose monitoring has evolved to allow for an increasingly improved experience for the patient with diabetes, and with a few simple steps, any frustration with the devices can be minimized, according to a speaker here.
Speaking at the American Association of Diabetes Educators annual meeting, Adam Brown, senior editor at diaTribe, said that, like all technology that came before it, continuous glucose monitoring, or CGM, had its drawbacks when the first-generation devices found their way into the hands of early adopters.
“In the scope of diabetes technology, CGM is a relatively young phenomenon, and I think health care providers are still getting familiar with it,” Brown, who also has type 1 diabetes, told Endocrine Today before his presentation. “There is a lot of baggage among health care providers that CGM isn’t accurate and that people are frustrated by it, in part because the early generation [models] were not particularly good.”
Today, Brown said, the landscape is much different.
“We’ve now graduated to a place where we’re not in the Palm Pilot era of CGM anymore,” Brown said. “We’re getting into the iPhone era.”
Calibration is key
When calibrating CGM sensors, patients should remember to wash their hands before every fingerstick test, enter the blood glucose reading right away, and avoid using old or previous sensor readings as a calibration, Brown said.
“It’s frustrating to get an alarm that your glucose is high when glucose is in range or even low,” said Brown, also the author of the book Bright Spots and Landmines, published this spring. “These issues can often be mitigated with better calibration practice.”
Patients should also keep in mind that blood glucose meters are not perfectly accurate devices, Brown said.
“I think people are often surprised when they hear that,” Brown said. “But, for people who have checked three, four, five times in a row, you can just see the variance. Where things get really dicey is when people don’t wash their hands before checking glucose.” Brown recommended that when handwashing isn’t available, wiping the first drop after a fingerstick and using the second drop is a good workaround.
As CGM technology has evolved to use the sensor readingfor insulin dosing, like with the Dexcom G5, this becomes even more critical, Brown said. But real-time changes to the technology are underway: Dexcom’s new G6 will require one calibration per day, whereas Abbott’s Freestyle Libre sensor, available in Europe but still under FDA review in the United States, does not require any calibration. Medtronic also hopes to move to no-fingerstick calibration for its devices long-term, Brown noted.
Right device, right patient
It is important that diabetes educators make themselves aware of what devices are available and keep in mind a patient’s individual needs. Cost, Brown noted, is often a driver in technology decisions for patients.
Other important considerations include how the device looks on the body, how large it is, what the insertion process is like, connectivity to apps and ease of use, Brown said.
Brown also recommended that diabetes educators not only read up on the latest devices, but try them on for size. Wearing devices, Brown said, is the best way to understand the patient experience and the pros and cons of each available model.
“All of the most empathetic and brilliant health care providers I know do this,” Brown said. “I often joke that all CGM manufacturers should have every medical student in the country wear CGM, because it is such an eye opener for them when they wear it. It’s a speedometer for your glucose. You get an immediate sense of what it’s like.”
As the evolving technology becomes more engrained in diabetes care, Brown said, the role of the CDE will only grow.
“Diabetes educators are going to be more important than ever,” Brown said. “This stuff is all about asking people talking to people, asking questions, troubleshooting, being creative and great experiences. That’s what diabetes educators are really good at.” – by Regina Schaffer
Reference:
Brown A. Diabetes Technology in the Wild: What Matters to Patients and How to Keep Up. Presented at: American Association of Diabetes Educators; Aug. 4-7, 2017; Indianapolis.
Disclosures: Brown is an employee of Close Concerns and a volunteer for diatribe.org.