Let’s face it, acronyms are popular. And if you’re even halfway involved in the diabetic community, you’ve probably heard and seen the word “CGM” thrown about a lot.
CGM stands for “continuous glucose monitor,” in case you forgot. Even individuals who are familiar with the phrase may struggle to understand what a CGM is, how to choose the proper one, how to calculate cost and insurance coverage, and where to purchase one.
This DiabetesMine primer on continuous glucose monitoring is a good place to start. We’ll start with the fundamentals and try to answer all of the nitty-gritty inquiries we can.
Whether you’re a newly diagnosed adult with diabetes of any type, the parent or guardian of a child with T1D, or a caregiver.
What is it?
A continuous glucose monitor, or CGM, is a small medical device that continually checks your blood glucose levels in real time (with a 5-minute gap between readings).
To use a CGM, you place a small sensor on your abdomen (or arm) and penetrate the top layer of skin with a tiny plastic tube known as a cannula. The sensor is held in place by an adhesive patch, which allows it to take glucose readings in interstitial fluid (the fluid that surrounds cells in the body) all day and night. Sensors should be replaced every 7 to 14 days in most cases.
The method sends real-time readings wirelessly to a monitor device that displays your blood glucose levels thanks to a small, reusable transmitter connected to the sensor. Some systems include a separate monitor, and others now display information using a smartphone app, so you don’t have to carry about an extra device.
Apart from the continuous stream of data, most CGMs may send alerts when your blood sugar levels rise too high or fall too low. You can also adjust your alert parameters and how you’re notified.
To say that CGMs have changed diabetes care is an understatement. CGMs provide continuous, dynamic glucose information every 5 minutes, unlike standard fingerstick (blood glucose metres), which only provide a single glucose reading. In a day, that works out to about 288 readings.
How Continuous Glucose Monitors Affect Diabetes Patients’ Lives
The goal is to empower people, as these gadgets have significant medicinal and lifestyle benefits.
To begin with, you can practically observe the impact of food and exercise on your blood glucose levels in real time, allowing you to spot cases of hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) as they occur, preventing potentially severe repercussions. This is a significant improvement over traditional “static” blood glucose monitoring, which only gives you a single glucose reading at a time.
There’s also the issue of convenience. CGMs can obviate the need for regular fingerstick tests, which have been the sole means to assess blood sugar levels for a long time. Fingersticks are still required to calibrate CGM devices and can be used as a backup data source, but they are no longer a persistent, irritating, and uncomfortable chore.
CGMs have also been demonstrated in trials to be one of the best outpatient blood sugar management alternatives for lowering A1C, the classic “gold standard” blood glucose management test.
According to other research, CGMs can help users raise their time-in-range (TIR), or the proportion of time spent in a healthy glucose range. TIR is quickly establishing itself as the new gold standard for determining favourable diabetes outcomes.
Continuous Glucose Monitors are especially useful for active youngsters (and adults) who want to ensure their safety during physical exercise and overnight glucose swings.
It’s also a potentially life-saving tool for diabetics who are ignorant of their hypoglycemia, alerting patients to imminent low blood sugars when their systems are unable to notice the warning indications.
There are four prominent Continuous Glucose Monitor systems
In the United States, four Continuous Glucose Monitor systems have been approved by the Food and Drug Administration (FDA).
Two require no fingersticks at all for calibration, while the other two now only require two fingerstick calibrations each day, compared to up to eight in the past—price and availability varieties.
Dexcom G6
based in San Diego Dexcom was the first to introduce a real-time CGM in this industry, back in 2006. The Dexcom G6 CGM is the most recent version, and it comes “factory calibrated,” meaning it doesn’t require users to set baseline levels with a fingerstick test. It has been FDA authorised for usage in youngsters as young as two years old.
Customizable alarms, connectivity with Dexcom’s Clarity software and smartphone app for data evaluation, and the option to effortlessly share device data with up to 10 followers are all features of the system (which can include your doctor, diabetes educator, caregiver, or family members). Apple’s Siri technology is also used for voice integration.
Indefinite retail cost per year without insurance
- Dexcom G6 transmitters cost a total of $1,200. A box of three Dexcom G6 sensors costs $4,800 in total (each sensor is supposed to last up to 10 days)
- The overall cost is anticipated to be $6,000 per year or $500 per month.
Each G6 sensor is designed to be worn for up to 10 days before needing to be replaced. Each new G6 sensor comes with a separate transmitter that clicks into the plastic base housing. Each transmitter lasts around 90 days until it needs to be replaced.
Medtronic minimed Guardian connect
The long-time pioneer in insulin pumps also makes a Continuous Glucose Monitor called the Guardian, which was previously only available as part of a package with its pumps. However, the FDA approved Medtronic’s Guardian Connect in March 2018, making it the company’s first stand-alone CGM in over a decade.
This device includes a tiny sensor that can be worn for up to 7 days on the upper arm or belly, as well as a Bluetooth transmitter that delivers glucose levels every 5 minutes to a cell phone app.
The main selling feature of Guardian Connect is protection, which is fitting given the product’s name. “The only Continuous Glucose Monitor device that lets patients on numerous daily injections outsmart highs and lows,” according to the manufacturer. Total anticipated cost: $6,000 per year, or $500 per month
Guardian’s smart technology not only forecasts where glucose levels are headed but also informs users 10 to 60 minutes before a “glucose excursion,” allowing them to make appropriate decisions to avoid high and low episodes in advance.
CGareM sensors and supplies are not sold in pharmacies, although they are available through mail-order distribution businesses and directly through Medtronic’s online purchasing hub.
Without insurance, Rough annual retail expenditures are:-
- $620 for a single transmitter (with a 12-month warranty
- $345 for a 5-pack of Medtronic Minimed Guardian Connect CGM sensors (each certified for 7 days of use).
- Total anticipated cost: $4,760 per year, or $397 per month
Abbott freestyle Libre
Abbott has long been a diabetic technology firm, but it only entered the CGM market in the last decade with its FreeStyle Libre Flash glucose monitor. It’s been accessible in other countries since 2014, and the FDA approved it in 2017.
A “flash” system differs in that users wear a small circular sensor placed into their upper arm, but it does not send readings automatically. To get glucose readings, users must manually swipe the portable receiver or smartphone app across the sensor. The FreeStyle Libre 2 is the most recent version, which was certified for use in the United States in 2020.
The sensor is small enough to be scanned through clothing and is about the size of two stacked quarters. It’s also waterproof, so you can use it while swimming or bathing. The sensor is also factory calibrated, so it doesn’t need to be calibrated, and it’s rated for 14 days of use.
Abbott’s LibreLink software, which allows up to 20 individuals to share data remotely, can read and analyse data on the receiver or a smartphone. The Libre is suitable for children aged 4 and up, according to the FDA.
In pharmacies, approximate pricing are as follows:
- According to Abbott, the list price for a 14-day sensor is $54 — often $58 to $69 in retail pharmacies like Costco and Walgreens.
- According to the firm, most customers with commercial insurance spend between $10 and $75 each month at participating pharmacies for the Abbott Libre 14-day sensors.
- $70 for a hand-held reader (not required if you use a smartphone app to scan the Libre 2 sensor)
- total: $1,582 to $1,868 for a year’s worth of service, or up to $160 a month
Eversense Implantable Continuous Glucose Monitor
The Eversense system, developed by Senseonics, is the world’s first long-term implantable CGM. It is made up of a little sensor the size of a twig that is implanted beneath the skin in the upper arm. It is by far the longest-lasting sensor, having been certified for 90 days of wear in the United States and 180 days in Europe.
A doctor must implant and remove the sensor, which is done by a small surgical incision beneath the skin at the clinic. An adhesive is used to secure a flat oval black transmitter over the insertion site. The transmitter must be removed and charged on a daily basis. An iOS or Android smartphone app is used to examine and control the system.
Senseonics resumed operations in September 2020 after receiving a cash infusion from Ascensia Diabetes Care, after being pushed into “hibernation mode” as a result of the COVID-19 pandemic. Ascensia, which also develops the Bayer Contour fingerstick glucose meters, is also selling and marketing Eversense.
Due to the impact of the COVID-19 pandemic, the company initially provided a $99 start price, which was terminated in 2020. That didn’t include the visits to the doctor’s office to insert and remove implanted sensors.
Without insurance, an estimate of the cost is as follows:
- Sensor insertion and removal costs are normally determined by a healthcare provider and range from $200 to $300 for insertion and $300 to $400 for removal
- Sensor insertion and removal costs are normally determined by a healthcare provider and range from $200 to $300 for insertion and $300 to $400 for removal
- $533 month $6,400 per year
Conclusion
For those with diabetes, Continuous Glucose Monitor technology has been a game-changer since it allows them to keep continual check of their glucose levels. CGM devices, unlike standard fingerstick metres, provide a more full view of how one’s blood sugars are trending both in the moment and over time.
Continuous Glucose Monitors are increasingly being linked to insulin delivery devices to develop hybrid systems that can modify insulin dosages automatically depending on glucose readings received via Bluetooth. People with diabetes will benefit from more lifestyle flexibility and better health outcomes as these “closed loop” technologies grow more inconspicuous and less expensive.
