Rethinking Glucose Monitoring for Diabetes

By Keith Gillogly

Now, continuous glucose monitors, or CGMs, can eliminate this constant task. Yet CGMs are often reserved only for people with diabetes who also take insulin, says Leonard E. Egede, MD. All individuals with diabetes, however, could benefit from their use, he says.

Egede, a SUNY Distinguished Professor and the Charles and Mary Bauer Professor and chair of the Jacobs School of Medicine and Biomedical Sciences’ Department of Medicine, is principal investigator on a new five-year, $3.8 million grant to study how adults with diabetes who aren’t on insulin could still benefit from CGMs.

The grant is funded by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. 

Insurance coverage often restricts providing CGMs only to individuals with Type 1 or Type 2 diabetes who also take insulin.

Yet less than 25% of adults with Type 2 take insulin, Egede says. This means that more than 75% of people with Type 2 don’t have access to CGMs. Egede adds that lack of insurance coverage for CGMs stems from limited data on their efficacy in adults with diabetes who aren’t on insulin.

Egede hopes to change this limitation.

The new study will involve three randomized groups of 300 people in Western New York with Type 2, poorly controlled diabetes who are not on insulin.

One group will receive CGM devices and instructions on their use. Another group will receive the devices and instructions and also get tailored health coaching for 12 weeks. A final group will not receive CGM devices or coaching and will monitor blood sugar using traditional glucometers.

The team will track a variety of clinical, behavioral and quality-of-life outcomes such as blood pressure and lipids and diet and physical activity among all groups and compare results and benefits.

While previous studies have indicated benefits of CGM use at 12 months, the current study will follow participants for an additional six months to see if benefits sustain at 18 months, Egede says.

CGMs, which are the size of a large coin, sit directly on the skin, often placed on the arm, Egede says. They take readings as frequently as every five minutes and can be connected to a device reader or a patient’s smartphone. 

The study team hypothesizes that individuals receiving CGMs will have better outcomes than those who don’t and that those who receive health coaching in addition will demonstrate the best outcomes.

Among the metrics being tracked is hemoglobin A1c, a reading of average blood glucose levels over the past two to three months and a benchmark of diabetes management.

While CGMs can monitor hemoglobin A1c, the near constant readings that they provide enable more precise, insightful metrics like glucose management indicator (GMI) and glycemic variability that offer a more immediate and comparable read on blood sugar levels, Egede says.

If the CGMs demonstrate benefit to people with diabetes who aren’t on insulin, Medicare, Medicaid and private insurance companies might more widely adopt the devices, as reducing morbidity and mortality will ultimately save health care costs, Egede says.

Diabetes is a long-standing problem and growing worse. More than 40 million Americans have the disease, and more than one in four adults with diabetes don’t know they have it, according to the U.S. Centers for Disease Control and Prevention. In the past 20 years, the number of adults diagnosed with diabetes has more than doubled.

Egede has been studying diabetes since his time as a medical resident in the 1990s. “In that era, that was just when glucometers were coming out,” he recalls. The devices were revolutionary but also expensive initially and adopted gradually.

CGMs, he says, have become the new glucometers. We have evidence that CGMs can positively change health behaviors and outcomes, Egede says, and all with diabetes should have affordable access to them.

“My career goal has always been that people should not have to suffer from diabetes,” Egede says “We have new technology. We have new medication. We should make it so easy for people to get the best care possible for diabetes.”