Shock news, CGMS works!
I rave about my pump and CGMS. My personal experience is that they’ve enabled me to keep my HbA1c at a very happy level for over 2 years, reduce the range of my blood sugar swings and reduce the number of hypos I experience. And now science agrees with me!
The latest research from JDRF shows that using a continuous glucose monitor regularly (at least 6 days a week) increases diabetes control and enables patients to maintain good control long term. This is exactly my experience.
My consultant never looks convinced when I tell him that I need to wear my CGMS pretty much all the time to achieve excellent results. He seems to think that I should be able to use it occasionally to get an idea of what’s going on, and then fly blind the rest of the time. My view is that CGMS is a tool I use to manage my diabetes day in day out, not something I dip into once a month to see how I’m doing. Now science agrees with me:
“patients averaging at least six days per week of CGM use had substantially greater improvements in HbA1c compared with those who used the devices less often” http://www.jdrf.org/index.cfm?page_id=112539
The other interesting bit from the study is the proof that the behaviour of the patient is as important in this as the technology:
“…the study found that regular use of blood glucose testing prior to beginning CGM therapy was an excellent predictor of regular CGM use and thus of improvement in glucose control” http://www.jdrf.org/index.cfm?page_id=112539
Yes CGMS is a great tool, but it is just that, a tool not a cure. I’d argue that if you were blood testing regularly prior to starting using CGM you’re probably someone who is used to putting the effort in to take control of diabetes. Common sense says a more advanced set of tools like CGMS is going to be most effective in someone who is used to making the most of the treatments available to them. I like it when science and common sense agree, it makes me feel that all is right in the world!
Hopefully this research will really help strengthen the argument for all those who are currently lobbying the NHS or insurance companies to provide them with access to CGMS. Good luck to you all!
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I’ve never had a great reception at the hospital when I’ve mentioned CGMS.
However, during my annual checkup I’m always asked how many time a day I check my BG. I usually say “5-6″ (for this is the truth) and all is well. I know that if I said “1-2″ then I would get a row for not testing enough. Therefore greater number of tests = Good Thing.
If CGMS tests your BG every 15 minutes that’s 96 times a day – therefore by the same logic as above CGMS must = Very Good Thing.
However, for some illogical reason CGMS = Bad Thing (or at least Ambivalent Thing) in the eyes of the docs. Je ne comprends pas?
@Tim From memory, I think CGMS checks every minute then updates the screen every 5mins based on the data it’s collected, so it’s even better than you think!
I got a frosty reception at hospital when I mentioned it too. I suspect several reasons:
1. It’s technology and not a drug – that means it takes more time to teach people to use and isn’t as simple.
2. It’s new – when I first got it there were very few studies to prove that it worked, just a few little ones. I based my case on the fact that I’d trialled it and it worked for me, which is what really mattered.
3. It’s perceived as being expensive – we can argue cost vs value all day, but my view is that cost isn’t a clinical issue. The Dr’s role is to decide if it is medically necessary, the PCT are the ones who have to decide whether they’ll pay for it.
4. I do occasionally get the “it’s not suitable for everyone” argument. Following which I assume I’m meant to say “ok, that’s fine, I’d forgotten all treatments have to be suitable for everyone and that it’s far too difficult to have a portfolio of treatments that we use according to patient need”.
They’re just my thoughts and I’m obviously having a cynical morning! It’d be great to hear from any clinicians as to why they think there seems to be a general reluctance to using CGMS.
@Alison Coo! Maybe the one I was looking at was just rubbish
I suspect your reasons are probably pretty accurate – especially the “New Technology” thing. In my view the medical establishment is not exactly open to new ideas.
@Tim There does seem to be a reluctance to embrace new tech, but I have to give my hospital some credit. After a lot of not so gentle persuasion they did come round to the idea of CGMS and have used it with other people since. As ever, you need a demanding consumer to drive the change.
A good debate would be: Which is more necessary, an insulin pump or CGMS? I know many type 1 athletes who do not pump, but use CGMS. Their A1c levels range from 5-6, and never any higher. Should CGMS take the forefront of diabetes care?
Great question. Ideally both because the CGMS provides you with the data and the pump provides you with the ability to react to that data. That said, I first trialled CGMS when I was still using MDI and it was useful – it helped me identify trends and the impact of certain foods. But it was when I got the CGMS and the pump together that I saw the real power – the CGMS told me I was rising slowly, the pump allowed me to give 0.2 of a unit to address that slow rise. The two combined are hugely powerful.
@Mark Good question, Mark.
It’s a bit of cop-out, but I think both are needed. My view is that we’re trying to manually emulate what our stupid broken pancreases used to do – which is constantly monitor BG and squirt out insulin in little bits all the time. CGMS and pumps are the closest we’ve got to this at the minute – therefore both combined they’re the best solution.
@Tim
Oh my! I cannot believe my eyes. Mr. “MDI” think both are the best? I think I need a drink.
In the immortal logic of the Talking Heads, Stop Making Sense.
Haven’t you Brits learned anything from us Yanks? Talking logically about health outcomes has no place in the hyperbole of the debate.
Ssssshhhhhh! Don’t tell anyone, but I’m actually on a “waiting list” for a pump at the minute…
You’re right – sorry! I’ll go back to ranting about the ‘communist’ NHS, etc.
@Tim Aye! The world’s comin’ to an end! And which pump did you choose?
Ha ha hahaha! *wipes tear from eye*
Ahhhh, I’m on an 18 month “waiting list” for funding and training. I’ll get to pick from a limited selection of pumps sometime in 2010 or 2011.
Needless to say, I’m cross.
Not only is he cross Mark, Tim’s also following the Alison approach to diabetes care and is lobbying hard to get his hospital to deliver the care they’re meant to deliver now, not just what they fancy delivering whenever. I’m so proud of him
@Alison Ah, yes, the “Alison Approach to Diabetes Care (TM)” aka “Bully People ‘Til They Give You What You Want (TM)”
@Tim It’s not bullying, it’s being an effective consumer. If any supplier didn’t do what I expected of them, I’d work with them to help them improve their service. I just do the same with my healthcare team.
@Alison Semantics, Alison, semantics
@Tim Bullying works for me, just ask Uncle Vinnie!
It’s amazing what happens when a little “pressure” is applied.
Interesting debate, indeed.
I currently have both a pump (Medtronics) and the integrated CGM system available. When I write available, it’s because I still do not use the latter full-time, except for the times I spend in Scotland, where it is absolutely my lifeline. Why do I not use it all the time when I have such great use of it, you may ask? Well, again money is an issue. Not that I’m paying for the sensors myself, but my hospital is, and even though the nurse told me that they had been allowed to just order the sensors for me that I need, I still sense a bit of “please cut down the cost”-attitude from the hospital
Also, and just as important, I feel like I need breaks from additional gadgets adhered to me from time to time, so this is why I usually don’t use the CGM all the time when I’m home in Denmark – afterall, there I have a “biological sensor”, i.e. my boyfriend for the past 7 years, who is all too aware of changes in my sugar levels, especially during the night where I do not sense them at all myself.
Despite all, I’m very grateful to have the CGM as a tool in my life, and after 3½ years with the pump, I’ve also – finally – seen the potential of it in my life. Toghether insulin pumps and CGM are probably the closed we can currently get to optimal treatment of diabetes.
@Heidi Partners are certainly a useful tool in diagnosing hypos, etc. I wonder whether the NHS should provide them for single diabetics?
@Tim
If they will not provide CGM you mean?
Interesting idea, although I’m not sure if we should trust NHS – or any other health or insurance related organisation for that matter – to select partners for single diabetics. Just think about the money that could cost if they had to provide proper training up front. Also, I’m not sure how many would actually reply to a job offer of that sort, financial crisis or not 
@Heidi Ah, what you need is a diabetes manager. I advertised for one a while ago but didn’t get any applications http://www.shootuporputup.co.uk/2009/05/15/wanted-diabetes-manager/
Resistance to CGM is about $. So many things to pay for health-care wise with just a certain amount of available money. Unless you are a diabetic, it is very hard to understand what it is like. Non-diabetics just think oh, you take insulin and everything is fine. The 24/7/365 part of it isn’t real to them. I was skeptical but I tried CGM for a few days and it ROCKS! The peace of mind was incredible.
@David On this side of the pond it’s all about £.
@Tim
Heh! Pounds or dollars, we all need insulin just the same!
@David Insulin – the international currency of wonky-pancreases
@Alison
All your Diabetes Managers are currently employed full time, unpaid by the NHS, looking after their children.
@ Heather
And they’re doing a great job, I just wish there were some to spare