Prescribing the right drug for the right patient is important for obtaining the best clinical results. The same concept is applicable to medical devices; choosing the proper device to fit the patient can make a world of difference in achieving the desired result.
Theoretically, a continuous glucose monitor (CGM) can be a benefit to anyone living with diabetes. However, identifying those patients who have the greatest need and who will benefit most from the technology can provide patients and healthcare providers with the quickest path to their goal of improving patients’ quality of life. Interestingly, the patients getting the most benefit from CGMs are not necessarily the patients in the best control prior to initiating the device. Studies have found that people with higher initial A1Cs often have the best reduction in blood glucose levels using the device.
Here are some other situations or patient characteristics for which CGM may be a good fit:
- Patients with type 1 or type 2 diabetes and who take either multiple-daily injections of insulin or use an insulin pump. These patients are generally at the greatest risk for hypoglycemia and increased variability in blood glucose numbers. In addition, research has shown that using a CGM for these patients leads to significant declines in HbA1c levels and hypoglycemic events. One study published in Diabetes Therapy on the use of Abbott’s Freestyle CGM saw, “significant reductions in rates of hypoglycemia below blood glucose levels of 70, 55, and 45 mg/dL by 55, 68, and 75%, respectively.”
- Patients with hypoglycemic unawareness. Hypoglycemic unawareness substantially increases a patient’s risk of severe hypoglycemia. These patients will benefit from the ability to identify and respond to impending hypoglycemia before it happens. Not only does this reduce the risk of hypoglycemia, but it can reduce patients’ anxiety. The IMPACT study using the FreeStyle Libre system, “demonstrated reductions of 40% in nocturnal hypoglycemia, 50% in serious hypoglycemia (<55 mg/dL), and 91% in routine fingerstick blood glucose measurements.”
- Patients who are pregnant. Strict blood glucose control is paramount during pregnancy to protect the baby and mother. Quickly being able to see the results of even minor changes in insulin and food intake can make patients feel more secure. Providers can also more quickly and easily adjust treatment plans without having patients slip into hypoglycemia. A 2017 study found that pregnant women who used CGM spent more time in range and had improved neonatal outcomes.
- Patients who are actively involved in or willing to become actively involved in their care. These patients check their blood glucose frequently and are aware of the crucial impact that diet and exercise can have on their numbers. As with anything else, the device is only useful if it is used by the patient and the data generated is understood and acted on, when needed.
- Patients who are technologically inclined or who have a technologically inclined caretaker. The patient or their caregiver doesn’t need to be a wunderkind of the latest gadgets on the market, but any patient that feels comfortable with basic modern technology is more likely to use the devices to its fullest potential.
These criteria are general suggestions and may not apply to all patients. A patient could fit multiple characteristics on this list and yet not feel comfortable with the added responsibilities of an invasive device. It is important to treat patients living with diabetes as individuals on their own unique journey. However, these situations and characteristics can help providers broadly identify patients who may benefit from adopting CGM into their lives. The next Practice Points piece will discuss CGM through the provider’s perspective: how can clinicians use CGM as a tool to improve patient outcomes without putting undue stress on the existing clinical workflow? Stay tuned to learn more.
—
Nora Saul is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Nora has more than 25 years of experience in the field of diabetes education, consulting for the Joslin Diabetes Center and other industry partners. Nora leads content development for Silver Fern’s diabetes products and training.