Transcription:
Continuous Glucose Monitoring

APrakash Chandran (Host):  For people with diabetes, it's important to keep your blood sugar levels in your target range as much as possible, to help prevent or delay long-term serious health problems such as heart disease, vision loss, and kidney disease. Today, we're going to learn more about a modern way to check your blood sugar levels with a continuous glucose monitor or a CGM. Here with us to discuss is Dr. Derick Adams an Endocrinologist for UK Healthcare. This is UK HealthCast, the podcast from the University of Kentucky Healthcare. I'm Prakash Chandran. So, first of all, Dr. Adams, it is great to have you here today. Let's just start with the basics here. What exactly is a continuous glucose monitor and what does it do?

Derick Adams, DO (Guest: So, thank you so much for having me. So, continuous glucose monitors or CGM for short is an important tool to help people manage their diabetes. It's a small electronic device that patients with diabetes would actually wear usually 24 hours a day, you can take it off to bathe in the shower. It's just about an inch in size, so it's pretty small, not very cumbersome to the patient.

And the device actually will monitor the blood glucose levels every five minutes. And then it sends that information to a receiver or even the patient's smartphone. So, it's very convenient for the patients to monitor their blood sugars. And it prevents patients from having to do finger sticks so often, which can be pretty painful. And it also gives a patient with diabetes, much more information about their blood sugars pretty much in real time.

Host: Yeah, that's pretty incredible. How long has the continuous glucose monitor been around for?

Dr. Adams: It's only been around for probably the last eight years or so. At first the technology wasn't as good or user-friendly, but it's quickly becoming one of the most important tools we have to help patients manage their diabetes.

Host: Absolutely. And you know, when it sends the information wirelessly, does it go to your phone, like to an app or does it go to some other device?

Dr. Adams: Most of the current CGMs actually use an app that'll just go directly to the smartphone. It can even go directly to a SmartWatch as well. So it's very cool. The patient can just look at their watch and tell their blood sugar, just like they were telling time.

Host: That is so crazy. And when we talk about where this little one-inch device lives is it typically like on your stomach? Is it on your back? Can you talk a little bit about that?

Dr. Adams: Yeah, most patients will wear it on their stomach. You can wear it on your arm or on your leg. But again, it's a pretty small device held on with just an adhesive, similar to what you see in like a band-aid. And usually it's not in the way for most patients.

Host: So, let's move on to the criteria for CGM coverage. What might that look like?

Dr. Adams: So because they are new devices, they are relatively pricey. So for most patients that have one they usually have to have insurance coverage for that. Most patients with type 1 diabetes and a lot of patients with type 2 diabetes will be able to have insurance coverage on most plans. A lot of insurance require that the patient be on three or more injections of insulin per day, and usually monitoring their blood sugar four or more times a day to qualify for a continuous glucose monitor. A lot of times the provider has to fill out paperwork to say that to get it approved through the insurance. But for a lot of patients who are on insulin, especially, we can get those approved.

Host: Okay. That's good to know. And let's talk a little bit about if the CGM sensors are approved for treatment decisions.

Dr. Adams: Yeah. So when they initially came out, you know, seven or eight years ago they weren't approved, but actually today they are approved. So you know, the patient can make decisions on how much insulin to give or whether to treat a low blood sugar. So, they are FDA approved actually now to make treatment decisions.

Host: Okay. Great. And I imagine that with time and with so much testing over the past eight years they have come to be more reliable than the traditional glucometer, right?

Dr. Adams: That's correct. They're at least just as reliable. And like I said, unlike a traditional glucometer, which just gives you your blood sugar whenever you check it, you can basically get your blood sugar anytime you want. So it's very convenient.

Host: Okay. So, you know, when people think about having this little device just attached to them all the time, I'm sure one of the things they think about is potential safety measures, right?

Dr. Adams: Well when they first came out and you used to actually have to calibrate them with a finger stick, like you would normally do. But as the technology has advanced that's not even necessary for the majority of the CGMs out on the market. The patient actually doesn't even have to calibrate the CGM at this point. Now sometimes for patients we tell them that if their blood sugar doesn't look right, like if they're suspicious that the CGM may be off for some reason, to go ahead and do a finger stick blood sugar, so they can verify that that's right. But for the majority of the time the CGMs are usually dead on and the nice thing about the CGMs is they actually have alarms on them.

So, the patient can go in and set an alarm to get notified if a blood sugar is too high or too low. And so, the patient can treat either a high or low blood sugar and avoid getting into trouble with that. So, it is really a lot of safety with the continuous glucose monitor and I've even seen people's lives saved because they were notified of the low blood sugar by the CGM. So, it's definitely a very good safety measure as well.

Host: That's incredible. So, if someone is listening to this and they fit the criteria for that CGM coverage, what is the best way they can go about getting one?

Dr. Adams: So, I would say the best way to go about getting one is to talk to your healthcare provider and ask them if you would be a good candidate for a continuous glucose monitor. Like I said, I think most people that would meet the insurance requirements would be, and I do think it's a very valuable tool to help manage either type 1 or type 2 diabetes. I would start by talking to your healthcare provider that manages your diabetes.

Host: Got it. And so, in addition to getting the actual monitor, is there any sort of education or training that's offered to the patients?

Dr. Adams: Yes, that is an important point you have this great tool with all this information. Patients definitely need education and training to be able to use that to its fullest potential. So, the patient will need to know how to put on the CGM and how to navigate all the features like the alarms that we were talking about earlier to use the CGM, but then another component of this is, if a patient gets blood sugar, you know, say it's a low blood sugar on a CGM, the patient needs to know what to do, how to treat that low blood sugar, and then going forward how to avoid that in the future. So, I think there's a lot of education that goes along with getting a continuous glucose monitor to help people use it to its fullest potential.

Hopefully a healthcare provider would be a good place for the patient to get the education. I know at UK Healthcare, we do have a Barnstable Brown Diabetes Education Center. And one of the focuses of that is to help people use technology to help care for their diabetes. So, we offer a good deal of instruction in classes focused around diabetes technology like CGM.

Host: Yeah, that sounds wonderful. And you know, just as we wrap up here, I imagine that there still might be people that are a little apprehensive about using a continuous glucose monitor, just because it's something that's always attached to them even with the trouble that it was before to kind of prick their finger. What might you say to them just around how far CGMs have come in the past eight years?

Dr. Adams: You know, it is a big step to have to wear something all the time. And I definitely understand that. And I definitely have had a lot of patients that are apprehensive about wearing a device or getting a CGM. But I would say for patients that are, just to give it a try, you know, at least for a month, or a few weeks. Most of my patients that have been apprehensive, find that the device is very accurate and it also saves them so much time and pain of checking their finger sticks and randomized control studies have shown this. Patients will actually have better glucose control with a CGM because they're able to use so much more information and adjust their medications and their activities to help manage their diabetes better. So, I would say just for the patient to give is try. I think they would find that it's very helpful. Cool.

Host: All right. Well Dr. Adams, I think that is a perfect place to end. Thank you so much for your time today. That's Dr. Derick Adams an Endocrinologist for UK Healthcare. Visit our website to learn more about the Barnstable Brown Diabetes Center @ukhealthcare.gov.uky.edu/barnstable-brown-diabetes-center.

If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks for checking out this episode of UK HealthCast with the University of Kentucky Healthcare. My name is Prakash Chandran, and we'll talk next time.