Personal CGM

How does personal CGM improve outcomes?

What is Personal CGM?

Provides patients with more complete information than fingersticks

  • Glucose sensors are inserted under the skin and measure glucose levels every 5 minutes, 24 hours a day.
  • Real-time glucose data is displayed, along with trends and the ability to see alerts.
  • Fingersticks are required to calibrate the glucose sensor and before making treatment decisions.

  • Fingerstick testing with 24-hour continuous glucose monitoring (CGM) provides far more information than fingerstick testing alone. Fingerstick testing alone may miss up to 60% of lows.1
  • 1Bode BW, Gross TM, Thornton KR, et al. Continuous glucose monitoring used to adjust diabetes therapy improves glycosylated hemoglobin: a pilot study. Diabetes Res Clin Pract. 1999;46:183-190.
     

    What is Personal CGM?

    How does Personal CGM improve outcomes?

    CGM Reveals Insights Beyond BGs and A1C

    When measurements are taken infrequently, one can miss vital data points.

    CGM takes readings every 5 minutes 24 hours a day, providing a more accurate understanding of glucose readings than infrequent BG meter readings.
     

    What is Personal CGM?

    How does Personal CGM improve outcomes?

    With large unmonitored glycemic variability, lowering target A1C can increase hypoglycemic events

    Target Glucose Range A1C = 8.0% A1C = 8.5% Time of Day Glucose (mg/dL) Continuous Glucose Sencor Readings Average Glucose Readings Midnight 3AM 6AM 9AM 12PM 3PM 6PM 9PM Midnight 100 200 300 400

    What is Personal CGM?

    Reduce variability first, then lower the target to improve A1C without increasing hypoglycemic events

    Target Glucose Range A1C = 8.0% A1C = 6.5% Time of Day Glucose (mg/dL) Continuous Glucose Sencor Readings Average Glucose Readings Midnight 3AM 6AM 9AM 12PM 3PM 6PM 9PM Midnight 100 200 300 400

    What is Personal CGM?

    In Conclusion

    • Personal CGM provides "Live" feedback*:
    • Glucose readings and TREND data to facilitate immediate decision-making
    • High and Low glucose alerts to help reduce glycemic excursions
    • Personal CGM unlocks advanced technologies
    • Pathway to the Artificial Pancreas
    • Connected Care sharing actionable data with care-partners

     

    Personal CGM (Init)

    What is the scientific evidence?

    2006 Guard Control CGM Study

    Study Design

    • 3 month study
    • 81 children and 81 adults
    • On intensive insulin therapy
    • type 1 (A1C > 8.1%)
    • 8 European centers
    • 7 Countries
    Outcome
    Personal CGM improved the outcomes of patients using intensive insulin therapy

    Guardian CGM
    • 50% of the subjects achieved an A1C reduction of ≥ 1.0%
    • 26% of the subjects achieved a reduction of ≥ 2.0%
    • No increase in hypoglycemia

    Deiss, D, et. al. Improved glycemic control in poorly controlled patients with Type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care. 2006;23(12):2730-2732.
     

    What is the scientific evidence?

    Higher utilization of Personal CGM is associated with better outcomes

    Study Design

    • 6 Month Study:
    • 322 Type 1
    • 114 children (8-14 years)
    • 110 adolescents (15-24 years)
    • 98 adults (≥ 25 years)
    • On intensive insulin therapy
    • Type 1 (A1C 7.0%-10.0%)
    Outcome

    • Change in A1C levels at 26 weeks
    Personal CGM BG Meter

    The Juvenile Diabetes Research Foundation published in The New England Journal of Medicine in 2008:359:1464-1476.
     

    What is the scientific evidence?

    Average A1C reduction for patients wearing CGM 6 days/week: 0.5%

    Percentage of patients who used sensors at least 6 days per week on average over 26 weeks
    Absolute Reduction in A1C (%) from baseline for all patients in each age cohort
    Higher utilization of Personal CGM is associated with better outcomes

    The reported results were for the entire population of each age group segmentation. The higher percentage of patients in each age group who used sensors at least 6 days per week over the 26 weeks, the higher the absolute reduction in A1C for all patients in each age group.

    The Juvenile Diabetes Research Foundation published in The New England Journal of Medicine in 2008:359:1464-1476
     

    What is the scientific evidence?

    Can Personal CGM reduce A1C for patients using intensive insulin therapy?

    Yes, frequent use of Personal CGM can reduce A1C by 0.5%-0.6% without increasing hypoglycemia when used with intensive insulin therapy.1

    1The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The New Engl J Med. 2008;359:1464-1476
     

    How do you get started with Personal CGM in your office?

    How do you get started with Personal CGM in your office?

    Four Steps:
    1. Identify candidates
    2. Set expectations
    3. Start patient on CGM
    4. Follow-up

     

    How do you get started with Personal CGM in your office?

    Patient Selection for Personal CGM

    Personal CGM can benefit a broad range of patients with diabetes. A task force of the American Association of Clinical Endocrinologists published a CGM consensus statement identifying the following candidates for Personal CGM:


    Patients with type 1:
    • with hypoglycemia unawareness or frequent hypoglycemia.
    • whose A1C is above target or with excess glucose variability
    • who require lowering A1C without increased hypoglycemia
    • who are pregnant or during preconception

    How do you get started with Personal CGM in your office?

    Personal CGM Effort

    Common patient misconceptions about Personal CGM

    • No training required
    • Personal CGM requires training and practice (like learning a sport or driving)
    • No more BG meter readings
    • Personal CGM does not replace BG meter
    • BG meter and Personal CGM readings should match exactly
    • Personal CGM will not always match BG meter readings

    How do you get started with Personal CGM in your office?

    Setting Expectations

     

    Once patients adopt Personal CGM into their lives, what is the most common reason they won't give it up?

     

    • Daily biofeedback leads to accumulation of lessons resulting in improved glucose control and quality of life
    • Learning real-time lessons every day to apply tomorrow
    • Patients will work through technical and therapy lessons as long as they expect them

    How do you get started with Personal CGM in your office?

    In Conclusion:

    • Personal CGM and pumps can lower A1C without increasing hypoglycemic events1,2
    • MDI to Pump: 0.5% A1C Reduction
    • BG meter to Personal CGM: 0.6% A1C Reduction
    • (MDI + BG meter) to (Pump + Personal CGM): 1.2% A1C Reduction
    • Personal CGM provides live3 feedback to facilitate decision-making
    • Glucose reading (every 5 min.)
    • Trends
    • High and Low alerts
    • Personal CGM unlocks advanced technologies
    • CareLink for therapy management
    • Connected Care for care-partners
    • Artificial Pancreas
    • To successfully implement Personal CGM in your office
    • Establish a protocol for selecting patients for Personal CGM
    • Set expectations before prescribing
    • Patients will experience Technical and Therapeutic frustrations
    • Personal CGM requires learning new skills

    1The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The New Engl J Med. 2008;359:1464-1476.
    2Raccah D, et al. Incremental value of continuous glucose monitoring when starting pump therapy in patients with poorly controlled Type 1 diabetes. Diabetes Care. 2009;32(12)245-2250.
    3A confirmatory fingerstick is required prior to making adjustments to diabetes therapy.
    4Keenan DB, et al. Accuracy of a new Real-Time Continuous Glucose Monitoring algorithm. J Diab Sci Tech. 2010;111-118.