Most adults with diabetes report CGM disruptions due to device problems, medical care
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Key takeaways:
- More than 80% of adults with diabetes using CGM reported at least one CGM disruption over the past year.
- Device malfunction and insertion problems were the two most common reasons for CGM disruption.
More than 80% of adults with diabetes using continuous glucose monitoring reported at least one instance of needing to stop using their device due to medical care or a device-related problem, according to survey findings.
“CGM disruption is the rule rather than the exception,” Alexis M. McKee, MD, CDCES, assistant professor of medicine at Washington University School of Medicine in St. Louis, told Healio. “The vast majority of individuals using CGM are not getting the full wear time out of every CGM sensor.”
McKee and colleagues conducted a retrospective survey of adults attending the Washington University/Barnes-Jewish Hospital Diabetes Center with type 1 or type 2 diabetes who use CGM. Demographics, the number of CGM disruptions and adverse events related to device disruptions occurring in the past year were collected. CGM disruptions were defined as device removal for the purpose of receiving medical care or any discontinuation of wear that was linked to a device malfunction, displacement or insertion problems.
The study was published in the Journal of Diabetes Science and Technology.
There were 99 adults who fully or partially completed the survey (mean age, 54 years; 70% women; 96% non-Hispanic white). Of the cohort, 69% had type 1 diabetes, 61% used an insulin pump and 41% used a hybrid closed-loop system.
CGM disruption was common among the respondents, with 14.6% of adults reporting no disruption. The mean number of CGM disruptions reported over the past year was 8.1.
Device malfunction was the most common device-related disruption reported, with 85.4% of all respondents saying they had at least one malfunction and 35.4% saying they had at least four malfunction-related disruptions. Insertion problems were the second most common device-related disruption, with 18.7% reporting more than four events. Sensor attachment issues were reported one to three times by 45.8% of the cohort and more than four times by 15.6%.
Medical care-related disruptions were most commonly observed during imaging, with 41.7% of respondents saying they had to remove their device for imaging. Of the cohort, 8.4% said they removed their device four or more times for radiology studies. CGM disruption was uncommon for participants during surgeries and procedures, and no participant reported more than three surgery- or procedure-related disruptions.
Lack of CGM use led to four or more occurrences of hyperglycemia in 36.5% of respondents and hypoglycemia in 12.4% of adults. Two people reported an ED visit, and no hospital admissions were reported.
CGM disruptions led to 19.6% of the cohort being unable use their device for 7 days or more. Of the cohort, 47.9% needed to replace their device one to three times during the past year, and 9.4% needed seven or more CGM replacements. A replacement device was received by 72.9% of adults during the past year, with the manufacturers covering most of the cost in 67.4% of cases.
McKee said there are several actions providers can take to reduce the frequency of CGM disruption for people with diabetes.
“Providers can reinforce proper insertion techniques and approved adhesives in addition to ensuring that patients know to contact the manufacturer to obtain a replacement CGM,” McKee said. “Unfortunately, providers are not able to prescribe additional CGM sensors at this time.”
McKee added that the frequency of CGM disruptions in the study should lead to more advocacy for CGM prescriptions to include an extra one-time refill.
For more information:
Alexis M. McKee, MD, CDCES, can be reached at ammckee@wustl.edu.
Perspective
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Ironically, the feature often lacking in continuous glucose monitoring is continuity. Interruption of CGM use can be both inconvenient and disruptive from a glucose management standpoint. While this applies to everyone with diabetes, it is most relevant to those using hybrid closed-loop systems, which depend on a steady flow of CGM data for making automated adjustments to insulin delivery. In this study, 41% of participants were hybrid closed-loop users, which reflects a fast-growing trend toward the use of this type of technology.
The good news is that CGM manufacturers will almost always replace defective or displaced sensors for free within a few days. However, all CGM users must be prepared and equipped to revert to traditional finger-stick monitoring any time CGM is unavailable.
Adhesive issues were noted as one of the most common causes of CGM interruption. This can usually be avoided by advising patients on proper choice of sites (avoiding areas of potential snagging or impact), skin preparation (clean, dry skin with no moisturizers) and use of available overtapes.
A common cause of CGM interruption not covered in this study involves depletion of supplies. Clinicians should take extra care to ensure that prescriptions are provided in a timely manner and encourage users to utilize dependable mail-order pharmacies that offer automatic refill services.
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