Continuous glucose monitoring, is it for everyone?
Jul 22, 2014, 01:00 AM
I have patients that consider their CGM the best addition to diabetes management since the discovery of insulin. I also have patients who have been disappointed, and one who even needed to see a psychologist after following every trend and pattern and literally ending up in tears.
Many studies support the effectiveness of CGM, particularly when used consistently. Trends and patterns can be spotted, acute hypoglycemia averted. The newest system (Enlite-Medtronic) will respond to a low BG value when communicating with their insulin pump utilizing an automatic suspend. What a blessing to parents and caregivers!
Given the upside of CGM, why doesn’t everyone want one?
As we all know, type 1 diabetes is a chronic disease requiring due diligence to achieve the strict guidelines that are set for preventing long term complications. We ask patients to check BG a minimum of 4-5 times per day, to wear a device that resembles a cell phone but that can never be removed for more than an hour at a time. We ask them to count carbohydrates and when ill and hyperglycemia results, to pee on a strip and check ketones. We coach them on adjustments for exercise, realizing that the adjustments do not always work from one exercise session to the next. We ask them to refrain from carbohydrates for meals to determine accurate basal rates, realizing that it is a helpful tool, but not always providing a consistent answer. For 24 hours a day, 7 days per week, type 1 diabetes can never really be set aside for a break.
Now enters CGM. A movie picture so to speak. It generally follows BG trending, and can provide a great retrospective look to determine what could have been managed in a different and perhaps better way. It can be set to predict a low or high BG as it follows glucose trending. However, it is not always accurate and can provide false alarms and false readings adding to frustration in an already unpredictable disease. It is also another piece of equipment that must be worn consistently and it is financially an added cost – and for some – a huge cost due to lack of insurance coverage.
So how do we help our patients decide if it is the step they want to take?
I believe almost every patient on multiple daily injections or insulin pumps should be educated on the option to choose a sensor; to understand both the benefits and the drawbacks and to realize it will take time to learn the ins and outs of utilizing a CGM. Using a professional CGM first, and reviewing the data with a patient, may help them see how they could use the information to promote better management of their diabetes. Freedom to choose, assessing the benefits, drawbacks and costs, and allowing the patient to decide if it is something they want to pursue is part of our job as educators.
How successful have you been at embracing this great optional technology with your patients? And if they choose to use it, what educational steps do you use to make the experience a positive one?