CGM as a lifestyle healthcare device. Such a bad idea?

When you wake up and check twitter, and find a storm of angry tweets in your stream, you might wonder what is going on. It doesn’t happen very often, but this morning was slightly different. I woke up to see this and the angry responses made it very clear what was going on…Following the Twitter thread, you can see that this gentleman, Andrew Wilkinson, has been using a continuous glucose monitor (Dexcom in fact) for a year or so and has some feedback for the company on it and the benefits that it has brought to him. https://twitter.com/awilkinson/status/1359871126164234244

But there’s also a spot more feedback on how it looks, what the app does and some of the responses to the thread from other lifestyle users complain about the insertion.

https://twitter.com/awilkinson/status/1359871127716155403

Perhaps unsurprisingly, especially when the Supersapiens launch feedback is taken into account, the responses to this from those with diabetes have been fairly critical. A typical response is:

I honestly have no idea how these people are getting access or being able to afford this tech. As a diabetic with a medical necessity, this tech is pretty damn expensive and inaccessible for those of us who NEED it.

— barbrie (@blink180bri) February 15, 2021

This latter point raises the question that most have in relation to access to Diabetes technology.

How do we get access to it and how do we make it affordable. In the context of access in the United States, it’s an even sorer point due to the costs of insulin, let alone CGM, and the insurance model that results in extremely unequal access to lifesaving medication, let alone monitoring systems. And as you dig through that thread, you’ll find that there are people saying they’re being charged $1,400 dollars for three months supply of Dexcom, compared to the ~$525 you’d pay in the UK (on subscription), just to add salt into the wound. Not only is pricing variable, it appears to be very mismatched.

There’s a clear sense of concern and profound unfairness that those wealthy enough to afford to buy a CGM off label in an attempt to improve their health are doing so at the cost of denying access to those for whom it may be life saving. This latter point remains questionable, as to it’s not clear that there is a real supply issue in the CGM world. For many access isn’t about the direct cost at all. When I looked at direct cost in 2018, we arrived at the conclusion that personal access to CGM in any form was a privilege and while the costs have gone down a little, that’s still the case. In the UK, help from the NHS makes a big difference, but basic access still remains a challenge for most.

And yet, I can’t help but consider the sudden rise in noise relating to Libre and Supersapiens that soon died way. And the potential that having a far wider range of people using CGM systems has.

As many people in the diabetes world will be aware, there has been rising excitement that Apple and Samsung have been trying to integrate non-invasive glucose monitoring in their watch products, and there are rumours that we’ll see the fruits of this in 2021. This isn’t just for those with Type 1. It is targeting a far wider range of people.

While it’s not clear that these will have any type of medical approval and are far more likely to be consumer products, why wouldn’t people with diabetes use them? As it stands at the moment, the only reason I can see would be the level of detection that they could go down to, which according to this 2020 paper, was tested at around 75 mg/dl.

If people with diabetes do use these consumer devices for their diabetes, in spite of the likely warnings (and why wouldn’t they?), what will this do to the purveyors of traditional invasive CGM systems? It’s possible to imagine a world where the only users of invasive CGM would be those using closed loop systems. That would be a nail in the coffin for the current providers, so why wouldn’t they broaden their marketing base, with the likes of Supersapiens with Libre and Levels with Dexcom? They potentially only have a short time in which to do that.

Add to this the forthcoming products from Abbott and Dexcom, in the Libre3 and G7, both of which are smaller CGM systems, with the suggestion that the G7 will be lower in price, and we can get a feel that the CGM market is likely to see significant change over the next couple of years.

And if the cost of accessing technology at a lower cost is to have more people using it, is that such a bad thing? The groundwork for that needs to be laid somewhere…

Yes, there is indignation in the type 1 community that something that is considered by many to be life saving technology is being used inappropriately, and comments about the look and feel compound what those feel about these products, but the reality is that those of us using CGM are the privileged few and the world is changing. Upcoming changes in CGM technologies have the potential to be very disruptive.

It’s worth remembering that 20 years ago, getting your blood pressure checked was the domain of the GP surgery, and yet for $25 you can now buy a device to do this at home, giving much better access to what could be life saving data.

If those without diabetes want to use CGM, and in the process, this leads to better ergonomics and aesthetics, but also reduces the costs and potentially improves access and acceptability, is that such a bad thing? Why stop them from doing so? Of course most people don’t know that porridge spikes glucose levels. Why would they? They have no need to.

Surely the bigger issue, and where our fight should be is in getting access for the many who would benefit from access to technology, and working with the diabetes technology industry to ensure pricing is at a level where you don’t need to earn £50k a year to be able to afford to fund such systems. If non-diabetic users help with this aim, what’s wrong with that?