If you don't know about Kelly Close and her work in the diabetes industry, you're definitely missing out. She's a Type 1 herself, a former Wall St. analyst, smart as a whip, and just about the sweetest person you could ever hope to admire.
We recall our grandparents talking about their first experience watching "moving pictures" — for that generation, a revolutionary development from still photographs. But that technology is quite primitive compared to the visually stunning pyrotechnics that are featured in theaters today.
In the diabetes world, we will someday recall self-monitoring of blood glucose (SMBG) with the same quaint fondness that our elders remember those early moving pictures. SMBG was indeed a revolutionary technology (in this case, from the poor proxy of urine tests), but home glucose monitoring was the equivalent of still shots, and we are now inching our way toward the moving pictures of continuous glucose monitoring (CGM).
We try to be cautious in forecasting how quickly any new technology will be adopted, but in the past week or so, the results of an important study has been released that make us have a more optimistic take about the acceptance of, and reimbursement for, CGM.
We were thrilled to see exciting news from the European Association for the Study of Diabetes (EASD) conference last week, which was simultaneously reported in the New England Journal of Medicine. Researchers reported the results from the JDRF CGM trials, showing that CGM use in adults resulted in a -.5% drop in A1c over six months for adults with about an 8% A1c baseline. That improvement is critical because many payers have been reluctant to cover CGM partly because there is not enough "medical literature" showing the merits of CGM — this literature is the best you could do — the New England Journal of Medicine!
The trial funded by JDRF and supported by all the manufacturers showed that in addition to a better A1c, there was also a corresponding rate of decreased hypoglycemia at the same time as A1c decreased, which we are all cheering about. Many will remember the landmark DCCT trial that showed intensive control caused lower A1c but with lots more hypoglycemia, especially severe hypoglycemia. While this trial included highly motivated patients with extraordinary health care teams and incredible psychosocial support, we hope it will serve as a model around the world to help patients seek better control — and that it will do a lot for insurance reimbursement!
We know that CGM use isn't for everyone, particularly for people who aren't yet ready to deal with its body image issues, and it's certainly far from being hassle-free. CGM also takes a lot of support from the health care team, so it's pretty hard to go on one if you are isolated or don't have a doctor or educator who sees its value. This trial didn't find, by the way, that CGM yet caused significant A1c reductions in teens or children — then again, teens used the devices only 30% of the time and children only 50% of the time — like that lotto tagline: "You can't win if you don't play." Here's to improving devices so that more people play.
On that note, we believe that CGM can be the same type of transformative technology that home glucose monitoring was, if the device companies work to make the technology more patient-friendly. We know that improvement with the devices — more accurate, smaller sensors, less painful insertion methods, etc. — will accelerate their use. And while we often hear from patients who've been denied reimbursement (sign Gina's amazing petition if you haven't already), coverage is actually moving faster than we had expected. For example, Medtronic estimates that the majority of its sensors sold last quarter were reimbursed — that's progress! Now let's get that to nearly all...
We know that we are fortunate to live in a country where these devices are even available. Many places around the world struggle to maintain basic insulin supplies. Our expectations are high as we eagerly await the advent of more combined devices (pump + CGM + who knows?) and more patient-friendly tools.
The show has just begun.
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Kelly Close is editor of diaTribe, a free online diabetes newsletter focused on research and new products, and President of Close Concerns, a healthcare information firm focused on the business of diabetes.