Considering a Continuous Glucose Monitoring System (CGM)? Here’s What to Look For
While continuous glucose monitoring systems (CGMS) are relatively new to the market, they are growing significantly in popularity. Industry experts estimate that total sales of CGMs nearly doubled between 2008 and 2009.
And with good reason. Studies have shown that patients who use continuous glucose monitors maintain longer periods in the normal range for blood sugar levels, than those using only the finger stick method. Over the long term, this can significantly lower your risk for complications.
According to the findings of the Diabetes Control and Complications Trial (DCCT), maintaining an A1C level of 7.2% compared to 9.1% can reduce your risk of retinopathy by 76%, neuropathy by 60% and nephropathy by 50%. That's excellent incentive to get a tighter grip on overall blood glucose levels, and a continuous glucose monitoring system [http://americandiabetes.com/living-diabetes/diabetes-supplies-articles/continuous-glucose-monitoring-diabetes] could make the difference.
Considerations in choosing a Continuous Glucose Monitoring System
There are several FDA approved devices on the market, each with varying features and benefits. Here are some key elements to consider as you consider your options:
Length of time on the market - Some companies have been making continuous monitors since 1999, while others have only been on the market a few years.
Communication with insulin pump available - Most of the models don't have this capability today, but there is one on the market that does. This may be especially important if you or a child has Type 1 diabetes, or extremely advanced Type 2 diabetes, and currently require a pump or may in the future.
Price - A variety of pricing models exist. Some have high upfront costs - as much as $1,300 for the system -- and lower ongoing costs for sensors. Others have lower upfront costs (as low as $450) and higher ongoing expenses for sensors, which might cost $240 or more a month. Other systems offer a compromise between the two extremes. While price is a big factor, be sure to compare all the other features to make sure you find a system that truly meets your needs.
Accuracy - Unfortunately, the accuracy of CGMs is still far from ideal, which is why the FDA has only approved the devices as a supplement to traditional finger stick testing. Variations in numerical accuracy (measured as MARD: Mean Absolute Relative Difference) ranges from 15% in some models to more than 20% in others. Clinical accuracy ranges from 95% to 98.9%. Talk to your doctor about what's best for your condition.
Calibration - A slight drawback to continuous glucose monitor is that all models on the market today must be calibrated frequently against the traditional finger stick method to ensure accuracy. Each device has different requirements and complexity. Look for the type of method that will suit your lifestyle best.
Sensor life - The FDA-approved life span of the sensor portion of the system ranges from 3 days on some models up to 7 days on others. However, many patients report the ability to wear sensors longer than the FDA recommendations.
Insertion device - The style and device of the sensor you choose could vary wildly. Make sure you're comfortable with the insertion method used before you purchase a particular system.
Display info - Each CGM has a different type of display style and available information, including trending info, rates and historical looks up to 24 hours back.
Predictive alarms - All CGMs on the market offer trending information, but some also allow you set alarms for anticipated thresholds for both high and low sugar. These devices can be set to monitor your blood glucose trending and sound alarms at different intervals, such as 15 or 30 minutes, before the device predicts you will reach the threshold.
Battery type and life - Both the transmitter and monitor will require recharging or battery replacement. Some devices can take up to 3 hours to recharge.
Built in blood glucose monitor - In many cases, a traditional BG monitor is built into the monitor portion of the system to help consolidate on the number of devices you have to keep track of.
Development - Consider next generation development possibilities for the continuous glucose monitors you're considering. Some companies are working on communication with an insulin pump while others are developing implantable sensors.
Other miscellaneous features - Numerous other considerations may be a factor in your decision. Some features to keep in mind include: Length and gauge of the sensor probe, angle of sensor insertion, sensor body surface size, monitor size, what type of computer software it works with, transmitter memory in cases of weak signal, distance of monitor range from transmitter, snooze alarm, money-back guarantee, warranty, upgrade programs and more.
Are you qualified for insurance coverage?
For many insurance companies, coverage of continuous glucose monitors is becoming more commonplace for certain patients. You may be covered if you have Type 1 diabetes and certain conditions are met, such as recurrent or severe hypoglycemia. You may also be covered if you have diabetes and are pregnant or if you have advanced Type 2 diabetes and your body no longer produces insulin. Contact your insurance company directly for more information.
Your doctor is the ultimate authority
No matter which CGM appeals most to you, your doctor will be very familiar with the pros and cons of different types, and which models will best help manage your care. Above all, remember that a continuous glucose monitor is not a substitute for traditional blood glucose checks, but a valuable addition to your care that can help you improve your overall health.
And with good reason. Studies have shown that patients who use continuous glucose monitors maintain longer periods in the normal range for blood sugar levels, than those using only the finger stick method. Over the long term, this can significantly lower your risk for complications.
According to the findings of the Diabetes Control and Complications Trial (DCCT), maintaining an A1C level of 7.2% compared to 9.1% can reduce your risk of retinopathy by 76%, neuropathy by 60% and nephropathy by 50%. That's excellent incentive to get a tighter grip on overall blood glucose levels, and a continuous glucose monitoring system [http://americandiabetes.com/living-diabetes/diabetes-supplies-articles/continuous-glucose-monitoring-diabetes] could make the difference.
Considerations in choosing a Continuous Glucose Monitoring System
There are several FDA approved devices on the market, each with varying features and benefits. Here are some key elements to consider as you consider your options:
Length of time on the market - Some companies have been making continuous monitors since 1999, while others have only been on the market a few years.
Communication with insulin pump available - Most of the models don't have this capability today, but there is one on the market that does. This may be especially important if you or a child has Type 1 diabetes, or extremely advanced Type 2 diabetes, and currently require a pump or may in the future.
Price - A variety of pricing models exist. Some have high upfront costs - as much as $1,300 for the system -- and lower ongoing costs for sensors. Others have lower upfront costs (as low as $450) and higher ongoing expenses for sensors, which might cost $240 or more a month. Other systems offer a compromise between the two extremes. While price is a big factor, be sure to compare all the other features to make sure you find a system that truly meets your needs.
Accuracy - Unfortunately, the accuracy of CGMs is still far from ideal, which is why the FDA has only approved the devices as a supplement to traditional finger stick testing. Variations in numerical accuracy (measured as MARD: Mean Absolute Relative Difference) ranges from 15% in some models to more than 20% in others. Clinical accuracy ranges from 95% to 98.9%. Talk to your doctor about what's best for your condition.
Calibration - A slight drawback to continuous glucose monitor is that all models on the market today must be calibrated frequently against the traditional finger stick method to ensure accuracy. Each device has different requirements and complexity. Look for the type of method that will suit your lifestyle best.
Sensor life - The FDA-approved life span of the sensor portion of the system ranges from 3 days on some models up to 7 days on others. However, many patients report the ability to wear sensors longer than the FDA recommendations.
Insertion device - The style and device of the sensor you choose could vary wildly. Make sure you're comfortable with the insertion method used before you purchase a particular system.
Display info - Each CGM has a different type of display style and available information, including trending info, rates and historical looks up to 24 hours back.
Predictive alarms - All CGMs on the market offer trending information, but some also allow you set alarms for anticipated thresholds for both high and low sugar. These devices can be set to monitor your blood glucose trending and sound alarms at different intervals, such as 15 or 30 minutes, before the device predicts you will reach the threshold.
Battery type and life - Both the transmitter and monitor will require recharging or battery replacement. Some devices can take up to 3 hours to recharge.
Built in blood glucose monitor - In many cases, a traditional BG monitor is built into the monitor portion of the system to help consolidate on the number of devices you have to keep track of.
Development - Consider next generation development possibilities for the continuous glucose monitors you're considering. Some companies are working on communication with an insulin pump while others are developing implantable sensors.
Other miscellaneous features - Numerous other considerations may be a factor in your decision. Some features to keep in mind include: Length and gauge of the sensor probe, angle of sensor insertion, sensor body surface size, monitor size, what type of computer software it works with, transmitter memory in cases of weak signal, distance of monitor range from transmitter, snooze alarm, money-back guarantee, warranty, upgrade programs and more.
Are you qualified for insurance coverage?
For many insurance companies, coverage of continuous glucose monitors is becoming more commonplace for certain patients. You may be covered if you have Type 1 diabetes and certain conditions are met, such as recurrent or severe hypoglycemia. You may also be covered if you have diabetes and are pregnant or if you have advanced Type 2 diabetes and your body no longer produces insulin. Contact your insurance company directly for more information.
Your doctor is the ultimate authority
No matter which CGM appeals most to you, your doctor will be very familiar with the pros and cons of different types, and which models will best help manage your care. Above all, remember that a continuous glucose monitor is not a substitute for traditional blood glucose checks, but a valuable addition to your care that can help you improve your overall health.