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Analysis: How Patients and HCPs Really Feel About CGMS

Mar 24, 2018
 

Both patients with diabetes and health care professionals expect wider adoption of CGMS — continuous glucose monitoring systems — in the future for patients with type 2 as well as type 1, and agree that cost is a key factor in patient choices

In partnership with PiperJaffray, Diabetes in Control reached out to patients and their families, doctors, nurses, and diabetes educators to gather opinion on the current and future role of CGMs in diabetes management. Our respondents have told us what they like and dislike about CGMs, why they — or their patients — choose to use one or not, and how they would like CGMs to improve. We’re proud to share the results of this exclusive survey with you.

Key Takeaways

• Both patients and HCPs indicated strongly that they expect CGM adoption to grow dramatically over the next 5 years
• Both patients and HCPs expect use of CGMs among patients with type 2 to become more widespread over the next five years
• Both patients and HCPs believe the main factor that discourages patients from using CGMs is their cost
• Patients who use CGM regard the ability to see glucose trends over time as their greatest benefit
• HCPs cite reducing time spent in hypoglycemia as the most important outcome measurement when using CGMs, followed by increasing time in range
• For the next generation of CGMs, HCPs want to see reduced cost and better accuracy, while patients want reduced cost, better accuracy, and longer sensor life

Analysis and Charts: Patients, Family, Caregiver
73% of respondents

Unsurprisingly, most respondents on the patient side of the survey were people dealing with type 1 diabetes (73%), reflecting the fact that most current CGMS users have type 1, and those already familiar with CGMS are more likely to have strong opinions on the technology. Across respondents – those who are using or considering CGMs, and those who are not – the cost of the systems was cited as key concern about CGM.

What type of diabetes do you/they have?
What type of diabetes do you/they have?

Currently, 61% of respondents use a CGM, with 36% using a fingerstick; 70% of respondents expected to switch to CGM in the future. Importantly, many respondents with type 2 expect to use CGM in the future. Since the number of people with type 2 diabetes is so much larger than the number of people with type 2, the needs and preferences of people with type 2 may have a huge impact on future CGMS design and use.

Percent of CGM Users with Type 1 vs. Type 2, Current and Future
Percent of CGM Users with Type 1 vs. Type 2, Current and Future

 

What do you/they use to monitor your glucose levels on a regular basis?
What do you/they use to monitor your glucose levels on a regular basis?

 

How do you/they plan to monitor your glucose levels in the next 3-5 years?
How do you/they plan to monitor your glucose levels in the next 3-5 years?

 

What Patients Like and Don’t Like About CGMS

The survey respondents who currently use CGMs indicated that the best thing about the systems was the ability to see glucose trends (24%), followed closely by alerts to their highs or lows (20%) and making their diabetes management easier (20%).

 

What are the BEST things about CGM? (select all that apply)
What are the BEST things about CGM? (select all that apply)

 

And while various things about CGMs annoyed many respondents, the most widely cited drawback to CGMs is their cost (30%). Lower cost is also what they want to see in the next generation of CGMs, along with better accuracy and longer lasting sensors.

For patients who do not use or intend to switch to CGMs, cost is also the main factor, with 38% of respondents stating the systems are too expensive. Lower cost and better accuracy were the main areas of improvement that might get them to change their minds.

 

CGM Users:

CGM Users: What are the WORST things about CGM? (select all that apply)
What are the WORST things about CGM? (select all that apply)

 

 

If you had to pick one, what features should the next generation CGMs improve upon?
If you had to pick one, what features should the next generation CGMs improve upon?

 

NON-CGM Users:

Why are you/they not interested in CGM? (select all of the following that apply)
Why are you/they not interested in CGM? (select all of the following that apply)

 

What would need to change about current CGM technology to get you interested in adopting CGM?
What would need to change about current CGM technology to get you interested in adopting CGM?

 

Popular CGMs

Of patients currently using CGM, Dexcom is by far the most widely-used system (72%), followed by Medtronic and Abbott’s FreeStyle Libre. While the majority of respondents indicated they expected to be using Dexcom in the future, both it and Medtronic saw a reduction in their percentages as many respondents indicated interest in other options for the future.

Which CGM do you/they currently use?
Which CGM do you/they currently use?

 

Which CGM do you/they plan on using in the future?
Which CGM do you/they plan on using in the future?

 

The majority of CGM users did not expect to change their CGM in the future, but for those who planned to change, accuracy, cost, and technology were the main drivers.

If you/they switched, what was the main reason for the change?
If you/they switched, what was the main reason for the change?

 

 

Dexcom, the most widely used system, also enjoys a good reputation with the majority of users across multiple criteria. The only metric in which Dexcom received a lower rating than the other CGMS listed was cost, where it was ranked lower than Abbott’s FreeStyle Libre. As cost was one of the key factors respondents cited as a reason they might switch systems, some may be planning a move to FreeStyle Libre or other lower cost solutions that may enter the market in the next few years.

Comparing CGMs
Comparing CGMs

Other Factors Pertaining to Cost & Insurance Coverage

Both Dexcom and FreeStyle Libre are covered by Medicare; 61% of those surveyed felt Dexcom was more appealing for those in Medicare, 10% favored FreeStyle Libre, and 29% had no opinion.

Users indicated they were willing to pay out of pocket for features they wanted, but many felt the current cost for those features was too high.

On a CASH pay basis (assuming no insurance coverage or discount cards), FreeStyle Libre costs $120 a month (3 sensors ~$40 each) compared to Dexcom at $210 (3 sensors at $70 each, assuming 10-day wear though some can get longer). Dexcom has enhanced features like alerts/alarms, link to any mobile device/smartwatch and share feature to allow friends/family to follow. On a monthly basis, how much do you think these extra features add in value (currently priced $90 more a month)?
On a CASH pay basis (assuming no insurance coverage or discount cards), FreeStyle Libre costs $120 a month (3 sensors ~$40 each) compared to Dexcom at $210 (3 sensors at $70 each, assuming 10-day wear though some can get longer). Dexcom has enhanced features like alerts/alarms, link to any mobile device/smartwatch and share feature to allow friends/family to follow. On a monthly basis, how much do you think these extra features add in value (currently priced $90 more a month)?

 

Health Care Professionals: Physicians, RNs, NPs, PAs; CDEs
27% of Respondents

CGM Use in Type 1 and Type 2 Patients

While 39% of their patients with type 1 are currently using CGMs, HCPs see a steady upward trend in the adoption of CGMs, estimating 77% of their patients will be using CGM five years from now. Dexcom is the most widely used system, but the HCPs expect both Dexcom and Medtronic’s percentages to trend downwards as FreeStyle Libre and new competitors gain ground.

What percent of your Type 1 patients are on CGM and how do you see that trending in the future?
What percent of your Type 1 patients are on CGM and how do you see that trending in the future?

 

Of your Type 1 patients using CGM, what percent use the following products?
Of your Type 1 patients using CGM, what percent use the following products?

 

 

HCPs believe CGM usage in patients with type 2 will soar in the next five years. Currently, they estimate 11% of their patients are using CGM; in five years, they expect that will increase to 46%. The FreeStyle Libre system may be a factor in that change, as they indicate the majority of their patients who are interested in FreeStyle Libre have type 2 (60%, vs. 40% who have type 1). As a new entry to the market, FreeStyle Libre may gain ground among type 2s who are less likely to already be loyal to an existing system like Dexcom.

What percent of your Type 2 patients are on CGM and how do you see that trending in the future?
What percent of your Type 2 patients are on CGM and how do you see that trending in the future?

 

HCPs recognize the role CGM cost plays in their patients’ interest in using a CGM. The expense of the CGM was the key reason they cited for patients did not want a CGM, or chose to stop using one. For Medicare patients, some HCPs indicate a preference for Dexcom over FreeStyle Libre (both systems are covered) but most think both are good solutions and the patient can decide which they prefer. Like their patients, they believe lower cost is the most important feature next generation CGMs should improve upon, closely followed by better accuracy.

Of the following, what are the most common reasons why patients do not want to try CGM or have stopped using CGM? (select all that apply)
Of the following, what are the most common reasons why patients do not want to try CGM or have stopped using CGM? (select all that apply)

 

Comparing CGMS
Comparing CGMS

 

Both Dexcom and Abbott's FreeStyle Libre have Medicare coverage, for those specific patients which CGM would you recommend?
Both Dexcom and Abbott’s FreeStyle Libre have Medicare coverage, for those specific patients which CGM would you recommend?

 

If you had to pick one, what features should the next generation CGMs improve upon?
If you had to pick one, what features should the next generation CGMs improve upon?

 

The greatest benefit of using a CGM is reducing time spent in hypoglycemia, cited by 79% of the HCPs surveyed, followed by increasing time in range.

When utilizing CGM, please rank the following outcome measurements in order of importance (1 most important).
When utilizing CGM, please rank the following outcome measurements in order of importance (1 most important).

 

 

Data: PiperJaffray diabetes survey (n=339) from Feb 13-26, 2018 consisting of patients, physicians, nurses and CDEs