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Bruce Bode Part 6, Continuous Glucose Monitoring (CGM) Devices

Dr. Bruce Bode talks with Diabetes in Control Publisher Steve Freed during the ADA 77th Scientific Session in San Diego about the future of CGMs.

Dr. Bruce Bode, MD, FACE  is a professor of medicine at Emory University School of Medicine in Atlanta, GA. He has a strong affinity for working with children and young adults with diabetes and is considered one of the leading experts in the world on insulin delivery and glucose sensing. He is very active in clinical research on new diabetes products including pharmacological agents to prevent diabetes and control glucose and new insulins and glucose sensors.

Transcript of this video segment:

Steve Freed: Let’s change the topic a little bit from pumps to CGM. How big of a deal is that?

Dr. Bode: So, having CGM out there as you know, Continuous Glucose Monitor systems are improving all the time. Every time I come here, there’s something better and every time I come here I see three or four new type of systems in development. These are phenomenal. As you know Dexcom is going for an indication of a 10-day sensor with one calibration a day and a much smaller transmitter. That’s great. We got Abbott Libre Flash, which has a professional sensor, but it’s a small little disk that the transmitter’s disposable and you don’t have to prick your finger. That’s not approved in the U.S., but it’s approved in Europe and there’s over 300,000 people paying cash for it. You come to these meetings now and you look at other sensors. I looked at a sensor that goes right underneath your arm. It’s the size of a kernel of corn. It’s an optical sensor. It’s in the MARD of 8%. Right now, they’re hoping to get approval for 90 days in the U.S. but they’re pending approval for 180 days in Europe. They’re working also over in Europe on a one year sensor and you might calibrate it once a day or maybe twice a day or hopefully eventually once a week. Or maybe twice a month. Another sensor that was there and it was one year sensing and it’s powered, everything is powered and it’s giving off a signal completely all the time. You still calibrate it but they hope to calibrate it once a week. If that can happen, you have continuous sensing, that’s a game-changer.

Steve Freed: Do you think that will basically take the blood glucose monitoring company pretty much out of business? If the prices are at least comparable?

Dr. Bode: For blood-glucose monitoring, if these become comparable to pricking your finger and it’s comparable in price, why would somebody prick their finger? Pricking your finger is painful. I don’t like pricking my finger, but people with diabetes, once you prick it 1,000 times it doesn’t hurt anymore. Sensors don’t really hurt that much going underneath the skin. I think you’re always going to have point of care testing, both for diagnostic in the clinic, you prick their finger when they come in, making sure they aren’t low and high, but then also people who have just mild type 2 diabetes, they just want to check once a week and they’re borderline, they can do that instead of using a CGM. I think there’s a role for both. But it has to get down in price, sensing. Right now, the Abbott Libre Flash, it’s inexpensive. It’s 14-day sensor, 50 euros for two weeks. If you can get down to $4 a day or $3 a day, that’s very inexpensive.

Steve Freed: Your kind of interested or excited about things that are coming down the pipeline that you know for sure, most likely are going to get here, they’re just waiting to do their final things and submit it to the FDA, so it’s actually here, we’re just waiting for approvals and things like that. How is that going change your practice?

Dr. Bode: I think in our practice in really the masses once we have CGM and we can easily put them on them and see what’s going, the patient will come back and say “Doc, you know, every time I eat cereal in the morning, I’m going really up, but if I have bacon eggs, that’s not good for my heart, my sugar’s flat.” Cereal has a lot of carbs in it, especially if you’re eating cereal, you got sugar cereal, Cracker Jacks, or whatever you’re doing, you’re going to come up. So people can learn what foods bring them up.  A lot of people say “Jeez, when I eat pizza I go up but then it stays up all night long. What’s that? What causes it?”  High fat foods cause marked insulin resistance. So people will learn when they see their sensor. But the sensor reading is right in their phone. Everybody now, you go down to the airport, everybody’s looking at their phone going down. On a busy sidewalk, everybody’s looking at their phone, so the sensor’s always there; people can see there it is.