How CGM Technology Is Transforming Diabetes Management

November 06, 2023 - Continuous glucose monitoring (CGM) has revolutionized diabetes management over the years, offering a more convenient and efficient way to monitor blood glucose levels. In a recent interview with LifeSciencesIntelligence, Arti Masturzo, MD, MBA, Chief Medical Officer at CCS, and Tina Platania, PharmD, Director of Clinical Services at CCS, explain the key advancements in CGM technology and its profound impact on diabetes care. 

The Evolution of CGM 

Continuous glucose monitoring was first introduced in the late 1990s and early 2000s as an alternative to traditional self-monitoring methods requiring frequent painful finger sticks.  

"With CGM, there is often a need for only one needle prick when attaching the device, though additional finger sticks may be required if symptoms or expectations do not match readings,” Masturzo explained. “Still, patients no longer have to remember to test their blood sugar several times a day, as these devices continuously monitor blood glucose levels." 

However, the early CGM devices were large and cumbersome to wear, challenging to set up, and interpret.  

"The second- and third-generation CGM devices that are now available are different. Device makers have simplified the process of attaching the sensor, making devices smaller and more comfortable to wear, and improved connectivity for data collection,” Platania pointed out. “Currently, CGM devices are being used as part of a closed-loop 'artificial pancreas' system for diabetes management, which takes burdens off of patients while keeping providers informed." 

Today's CGM systems are significantly smaller and worn comfortably for up to 14 days. Seamless data streaming eliminates the need for periodic scanning, offering real-time insights. They are also more accurate, require less frequent calibration, and can be integrated with apps to provide valuable information such as time in target ranges and correlations with activity or diet choices. 

CGM Devices 

CGM devices use a thin monofilament inserted under the skin and a sensor to measure blood glucose levels in the interstitial fluid surrounding cells. This eliminates the need for painful finger pricks and test strips. The data collected by the device can be accessed through a reader or a smartphone app, offering real-time alerts and detailed visualizations of blood glucose patterns. 

"This is a huge departure from traditional glucose monitoring, which provides only a single data point after a painful and inconvenient collection process,” Platania emphasized. “Traditional monitoring cannot provide alerts when someone enters a hypo- or hyper-glycemic state, making it challenging to collect data over time." 

Benefits of CGM Technology 

CGM technology offers numerous benefits to individuals living with diabetes. It provides immediate access to data, allowing patients to correlate it with other health factors like food choices, exercise, stress, and medication.  

This continuous feedback empowers patients to make informed choices, resulting in better blood glucose control, improved HbA1c levels, and reduced healthcare expenses. Moreover, it offers a discreet way to manage blood sugar, improving adherence and reducing stress. 

Masturzo shared a success story about a teenager with type 1 diabetes who struggled with self-management, resulting in an A1C of 13. When provided with a CGM, he took control of his health, improved adherence to insulin therapy, and made healthier food choices, lowering his A1C to 7. 

Another case involved a person with type 2 diabetes who was on maximum doses of oral treatment, yet his A1C remained at 10. Only after using a CGM, coupled with education and coaching from CCS clinical experts, did he make lifestyle changes that significantly improved his A1C levels. 

CGM devices have had a profound impact on patient outcomes and diabetes control. Studies in type 1 and type 2 diabetes populations have consistently shown reduced A1C levels, improved quality of life, and increased time in target blood glucose ranges. They also reduce the risk of chronic complications such as lower extremity amputations, kidney disease, and eye disease. 

The benefits of CGM are not limited to specific patient populations. Research shows that everyone, regardless of age or health literacy, can benefit from CGM use. Platania and Masturzo emphasized that providers should not rule out any patients as candidates for these devices. 

From a medical perspective, CGM innovations have simplified diabetes management for providers and patients. Real-time data and trend analysis enable providers to make personalized treatment decisions regarding medication dosages, food choices, and lifestyle changes. This collaborative approach between clinicians and patients results in better glucose control and fewer long-term health problems. 

Challenges and Future Developments of CGM 

While CGM devices have made significant advancements, cost and insurance coverage remain barriers to access. Future developments may include more efficient closed-loop systems and sensors that provide feedback on factors like carbohydrate intake and medication impact. 

Healthcare providers and diabetes educators incorporate CGM data into patient education and support programs to foster personalized care. CGM devices help patients set individual goals, make small changes, and build confidence. This approach results in practical, lasting changes that lead to better outcomes over time. 

Artificial intelligence and machine learning will likely play a significant role in the evolution of CGM technology. These advancements will make artificial pancreas systems more precise and sensitive, allowing patients to live their lives naturally without being controlled by their diabetes. 

Recommendations for Healthcare Professionals and Patients 

Masturzo and Platania encourage primary care providers to collaborate with specialists in diabetes care and work with health plans to improve access to CGM devices. Patients are advised to talk to their providers about trying CGM systems and continue using them as intended. 

The field of CGM technology is continually evolving, with numerous research projects and clinical trials underway. Diabetes is a significant healthcare challenge, and the potential for improving patient outcomes through CGM technology remains promising. 

CGM devices are becoming foundational remote patient monitoring devices that can be integrated with other home-based monitoring tools to manage chronic conditions and maintain wellness. They are even being explored in monitoring conditions like hypertension and high cholesterol and by athletes to enhance athletic performance. 

CGM empowers and engages patients, enabling them to understand their diabetes better and make informed decisions. They facilitate collaboration between healthcare providers and patients, resulting in lower costs, improved healthcare experiences, and better overall quality of life for people with diabetes. While CGM devices have promising applications beyond diabetes, Masturzo and Platania emphasized that it is crucial to ensure that everyone with diabetes can access affordable CGM devices.