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CGM Study Shows This Stuff Works!!!

My insurance company still says NO to my request for approval of a continuous glucose monitoring system.  But - a ha! - a study conducted by the JDRF has given me something to print out and mail along with my third appeal.  Thanks to several dozen emails this morning directing me to the study and special thanks to Cynthia Rice, Director of New Technology Access in Washington, DC, I now have the inside scoop on why insurance companies should listen up and listen good:

Kerri:  This study quantifies the value of a continuous glucose monitoring device for people with type 1 diabetes, in particular, for adults aged 25 and over.  How did individuals over the age of 25 fare using this device?

Cynthia:  The study found patients with type 1 diabetes who used continuous glucose monitoring (CGM) devices to help manage their disease experienced significant improvements in blood sugar control. Overall, adults 25 and over lowered their A1c by .53%; were more likely to lower their A1c by 10%; and were more likely to reach target below 7.0.

Kerri:  In regards to the younger group, the kids under 15, how were their results similar or different?

Cynthia:  Children under age 15 using CGM were more likely to lower their HbA1c by at least 10% and achieve HbA1c levels below 7% compared with non-CGM users.  At the same time, the average decrease in HbA1c was not significantly different in the CGM and non-CGM groups.  Although the study was not specifically designed to assess the effect of frequency of CGM use on A1c, an initial analysis of the data suggests that patients under 15 who used CGM at least six days a week or more lowered their A1cs just as much as adults.  On average, only 50% of children under 15 who used CGM used it six days a week or more.

Kerri:  What is the assumption about the 15 - 24 age group?  Why didn't the use of a CGM make a bigger impact on their A1c values?

Cynthia: 
Fifteen to twenty-four-year-old CGM users as a group did not experience significant improvements in glucose control compared with the control group.  Although it’s clear from a preliminary analysis of the data that teenagers were the least likely group to wear the CGM near daily (30%), the study was not geared to answer this question -- however, many families with teenagers will not be terribly surprised with the result.

Kerri:  At a session at CWD in Orlando this year, Bruce Buckingham discussed how CGMs work best for people who wear them at least six days a week.  Your study appeared to confirm this statement, at least for the 25 and older group.  How does duration of use affect results?

Cynthia:  In the study, CGM use varied with age, averaging at least six days a week over the course of the trial in 83% of the patients 25 years and older, but dropping off to 30% of the 15 to 24 year olds and 50% of the 8 to 14 year olds. Although the study was not specifically designed to assess the effect of frequency of CGM use on HbA1c, an analysis presented this week at a scientific conference suggested that patients within all three age groups, including teens and young adults, who used the device at least six days a week had substantially lower HbA1c levels after six months compared with patients who used CGM less than six days a week.

Kerri:  Many people with diabetes are fighting with their insurance companies to get their CGM systems approved.  How can this study help move patients towards approval?

Cynthia:  By showing that CGM use improves glucose control, this study, published in the prestigious, peer-reviewed New England Journal of Medicine, gives justification for expanded health plan coverage of CGM.  JDRF will be briefing health plans on these results and encouraging people with type 1 diabetes and their loved ones advocate to their own health plans to cover CGM.  You can help secure coverage for CGM by clicking here.

Kerri:  And lastly, how can we, as the diabetes community, get more involved and help move research forward?

Cynthia:  When you click on this link, you can not only help secure coverage for CGM, but sign up to receive emails from JDRF on how you can advocate for federal research funding and get involved in your local community to help move research forward.  

I am Kerri and I approve this CGM.  I wish you would, too!

Thanks for your time, Cynthia!  And for more information on CGM insurance coverage, you can visit the JDRF website, sign the CGM Anti-Denial Petition, and check for more CGM updates here on SUM.

Comments

Kerri! Typo in the first answer from Cynthia, it says 10% reduction in A1C and I'm pretty sure it should read 1.0%...

Alex - I just double-checked the response from Cynthia and it says 10% in her answer. Maybe CGMs are actually that good!

Silly me--I was misinterpreting the percent sign because in medicine A1Cs are actually reported as percent of hemoglobin that is is glycated. So what we say as 7 is technically 7%. I was reading it as it would drop from 7% to -3! haha. Now I see that it means it'll drop 10% of the total (so 7 would go to 6.3). Got it! Thanks for double checking! :)

WOOHOO! That's awesome--and promising for your quest to battle the insurance company!

I'm visiting the JDRF site to do what I can to help!

Kerri Here is another study from the New England Journal of Medicine. Good luck!

Continuous Glucose Monitoring Enhances Glycemic Control in Adults with Type 1 Diabetes


Continuous glucose monitoring improves glycemic control among adults — but not children — with type 1 diabetes, reports the New England Journal of Medicine online.


Some 320 patients aged 8 or older with type 1 diabetes and glycated hemoglobin levels between 7% and 10% were randomized to either continuous glucose monitoring (using a subcutaneous device that sends glucose measurements wirelessly to a receiver), or home monitoring with a glucose meter. Both groups were instructed in using data from the devices to adjust their insulin intake.


The primary endpoint — change in glycated hemoglobin at 26 weeks — significantly favored continuous monitoring only among patients 25 or older (mean change, –0.50% vs. +0.02% among controls). The change in glycated hemoglobin among younger patients did not differ between continuous and control monitoring.


Addressing the "observed age effect," the researchers note that adults used their continuous monitors more frequently than younger patients did.


NEJM article (Free)


Related Journal Watch link(s):

Duh! I just read through your post more carefully and see you already have this study cited. Sorry.

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