Adam Brown Part 3, Will CGM End Blood Glucose Monitors?

In part 3 of this Exclusive Interview, Adam Brown talks with Diabetes in Control Publisher Steve Freed about the hindrances to the more widespread use of CGMs and solutions.

Adam Brown, is senior editor and columnist at diaTribe.org, and head of Diabetes Technology & Connected Care at Close Concerns.

Transcript of this video segment:

Freed: Your thoughts on CGM? Do you think it’s going to basically take the blood glucose monitors off the shelf eventually? Because why would you want to stick yourself five times a day when you don’t have to.

Brown: Well, I think the operative word in your question is eventually. And everyone’s wondering when will that be and what will it look like in what populations. So, I think in type 1 diabetes, not having a CGM is dangerous. I mean, every single person with type 1 diabetes should have CGM.

Freed: How about everybody using insulin?

Brown: Yeah. And everyone using insulin, for sure, or certainly people on multiple daily injections with type 2 diabetes. What will — I think a couple of things are gating the field right now. So, one, is still reimbursement. Actually a lot of people are paying out of pocket for CGM even if they have coverage. Maybe they pay 20% or 30% or 40% of the CGM, but that can actually really add up and especially if you’re having trouble paying for your insulin. But what’s good is companies get it. They are making affordable systems. So, Libre came out in the US, much more affordable, sold in the pharmacy, less hassle hopefully for providers to prescribe. Dexcom just came out with G6 which is 10-day wear instead of seven. And they’re moving quickly to get to a disposable system that’s even less expensive. So, I think we’re going to see it — most people would say about 20% to 30% of type 1s in the US right now wear CGMs, so it’s still pretty early in type 1. And we’re going to see that explode with two factory calibrated systems now. I mean, I think that’s really going to open up the field.

And then in type 2, there’s just not a lot of studies showing the benefit, so that’s going to gate the coverage until we get more studies. And the other thing is often these things are tested like a drug; give one group the CGM, give one group finger-sticks, follow them over time, see how they do. CGM is a tool. It’s not a therapy, so you have to do something with the data. And so, the other thing people are working on is building education around the CGM. So, imagine if you took pictures of your meals, those pictures were overlaid on the CGM data, and then you would actually be prompted to say, “Here are the 10 meals that keep your blood sugar in range and here are the 10 that are challenging,” that is decision support and that will enhance the efficacy of CGM, but that stuff is still kind of early. The Sugar.IQ from Medtronic is kind of one of the first really cool pattern recognitions, I think, we’ve seen and we’ll see much, much more of that. And then the big question for kind of the world is, what about people with type 2 not on insulin? What about them? What about people with prediabetes, I mean would they ever wear CGM? And I hope so. People like Anne Peters, prescribes CGM to everyone she can get it for, people with prediabetes even. And so, I hope someone does those studies to prove it but it’s going to take time. Especially in developing countries, we’re going to need much less expensive systems. But I am a huge CGM advocate. I think everyone who we can get it for should be on it.

Freed: When are you going to use the Eversense?

Brown: (Laughs) Well, I’ve been a Dexcom user for a long time. I’m very happy with it. The other thing I’ll say is I’ve been using one of these do-it-yourself closed loop systems that some really smart patients hacked together, so I actually can dose insulin from my phone and I have a hybrid closed loop on that. Right now it only works with the Dexcom, so I’ll probably stick with the Dexcom until I get to survey kind of everything and see what I like. And so, we’ll see. I think Eversense is really exciting because it’s a new form factor for CGM. So, there are people who say, “I just can’t deal with the adhesive of CGM,” or, “I don’t like plunging a needle through my skin once a week.” And so, for that group Eversense will be really exciting. And then once they can get to 180 days and even 360 days, I think they’ll see hopefully more uptake too. But it’s still really early for Eversense.

Freed: I had a chance to talk to one of the reps just 10 minutes ago.

Brown: Yeah.

Freed: And asked him how much and he said, “It’ll be equal to what’s out there.”

Brown: Yeah.

Freed: And I said to him, “Well, the people that wear the Dexcom, to try to save money they may wear it one week a month, but you’re saying it’s going to cost like four weeks of — or it’s going to cost three months for sensors, that’s going to be kind of expensive because you can’t take it out. You’d have to use it.” And so, he came up with around five grand a year, which is almost the price of a pump.

Brown: Yeah, that sounds a little expensive. I think they said $10 a day on their earnings call, so that’s about $3,600 a year. I mean, an advantage they have is no receiver — so, with the Dexcom you have to buy the receiver when you get it. With Eversense there’s — and you can use an app for the Dexcom, but you have to buy the receiver. With Eversense, there’s no approved receiver, so the only way to use it is phone. So, that does pull out one piece of the cost. And as I said since it’s only one sensor instead of — if you’re using the Dexcom that’s 36 sensors a year, right, 10 days a sensor. If you’re using Eversense that’s four sensors a year. And when they get to 180 that’s two sensors a year. And when they get to a year, that’s one sensor. And so, they can spread out the pricing over fewer items and I think hopefully that will help them drive it down.

Freed: Well, they should have the six months sensor very soon because it’s available in Europe. It’s not like they have to reinvent the wheel.

Brown: Let’s hope not.

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