Visibility is key: Study shows that Continuous Glucose Monitoring has huge impact on A1C long term
Imagine piloting a boat on a river, as the river bends there are buoys between which one must navigate to remain safe.
This is a lot like what it is to live with diabetes. Waters may be calm, they may be turbulent; there may be no obstructions or the water might be strewn with debris and other vessels. What helps one safely navigate? Some might say “the boat” thinking that a more modern, high speed, high performance boat might make it a safer trip to port. This would be like the most up to date insulin pump therapy; high mobility, fast action, detailed correction and very flexible. Others may opt for a large sturdy and dependable vessel that can weather dependably to get them safely to their destination. This would be like using Multiple Daily Injection (MDI) therapy. Long acting insulins with little change in action over time, often coupled with fast or rapid acting insulin for covering meals and corrections.
However when it comes to safe navigation, by far the most important safety feature is good visibility! The same is true of diabetes management. We check our blood sugar to know where we are and where we need to go. No matter the features of the craft, even on the smoothest waters and the most experienced boaters will run aground or have a collision if they cannot see where they are going and what is coming! Imagine trying to guide a boat to harbor with your eyes closed, opening them for a split second every couple of miles and having to make all of your course corrections based on what you saw. This is essentially what we are doing when we monitor our blood sugar with self monitoring of blood glucose (SMBG) or what is often referred to as “finger sticks”. We are taking a glimpse every few hours along our day and making management decisions based on the available information. Even the most diligent patient, checking their blood sugar 8-10 times per day is only getting a limited view of what is actually happening to their blood sugar. The alternative is real time Continuous Glucose Monitoring(CGM). These devices are comprised of a sensor inserted into the subcutaneous fat layer, and a transmitter that it attached to the sensor on the skin’s surface. Together these devices are worn 24 hours a day, sending updated glucose levels every 5 minutes around the clock. This is like having a boat with a 360 degree view of the water. With this kind of information we can plan ahead, make course corrections sooner to avoid collision, and more optimally plot our journey.
In a recent presentation at the European Association for the Study of Diabetes (EASD) 2 years of data from the Comparison of Different Treatment Modalities for Type 1 Diabetes Including Sensor-Augmented Insulin Regimens (COMISAIR) found that the boat matters far less than the view. Study data was collected for 2 years on 65 individuals with diabetes. 15 participants used a pump with SMBG, 20 used a pump and CGM. 12 patients used MDI with SMBG and 18 used MDI with CGM. This was the longest ever trial for CGM use. Study results found that the A1C improvement of those participants not using a CGM was minimal from an average of 8.4 to 8.0 over 2 years. However the A1C improvement of those using CGM was 2-3 times that of SMBG users! Of those using a CGM more than half the participants were able to achieve and A1C of less than 7. The surprising result was that there was very little differentiation in outcomes between insulin pump users and those on MDI therapy. Given the same amount of education, guidance and monitoring, the two groups achieved statistically equal outcomes. The boat they drove made very little difference in the safety of the journey, what made the difference was visibility.
This can be very important information for patients for whom cost is a primary decision making factor in treatment of their diabetes. Both insulin pumps and CGMs have an upfront cost for many users, where MDI does not. Taking this study into consideration a patient may see the desired blood sugar management goals with MDI and a CGM, reducing the out of pocket cost of a pump and added supplies. Medicare has even approved CGM technology, making this technology available without the previous financial burden.
CGM technology has also been approved by the FDA for use in making treatment decisions, top of the line products requiring only two finger sticks daily for calibration. CGMs now are capable of achieving accuracy comparable to glucometers.
When it comes to life with diabetes, knowledge truly is power. The knowledge of what our blood sugar is doing, trends over time, and hidden highs and lows can make a huge improvement in our wellness and our quality of life. There is also a wealth of knowledge available for those who are using a CGM to be able to maximize its effectiveness, and to make the most of the data is provides.
Integrated Diabetes Services specializes in helping make the most of this information, transforming it into practical strategies tailored to help each individual reach their goals. For more information on whether CGM technology is right for you, or to try a CGM out as part of a trial reach out to us at Integrated Diabetes Services.