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Dace Trence Part 3, CGM and Type 2 Diabetes

In part 3 of this Exclusive Interview, Dace Trence talks with Diabetes in Control during the AACE 2018 convention in Boston about CGM and type 2 diabetes and the usefulness of CGMs for people who are not on insulin therapy.

Dace Trence MD, FACE is the Director of the Endocrine and Diabetes Care Center at the University of Washington in Seattle.


Transcript of this video segment, Dace Trence Part 3, CGM and Type 2 Diabetes:

Freed: You know when it comes to type 2 — well, first of all, I remember the first CGM which was the GlucoWatch, which I had one and it wasn’t very accurate. The thing would conk out on me, I mean every time I went for a walk and I had a little bit of sweat, so it was difficult. Never really went anywhere. But from that, they developed the newer technology which I find to be very educational. And do you see using it in a type 2? Well, we know that people who take insulin, it’s very effective. What about the people that are not on insulin, that are on other oral drugs, or even GLPs type of thing? Do you use that for those type of patients? Because I don’t — insurance won’t pay for it per se at this point in time. But I think eventually they will because I think that’s the best education in the world. You sit down, you have a piece of chocolate cake, and you look an hour later or 20 minutes later, you see it’s 800 or whatever the case may be, you’re not going to do that anymore. Have you seen it being used in type 2s and what is the end result?.

Trence: There is — I just actually reviewed the literature and there really is not much data outside the insulin program for people with diabetes. But there’s that in both types 2s and type 1s but they’re all on insulin, even the basal insulin minimally. So, I think your point is well made that we still need studies to really support that the use is proven scientifically. But with now the lesser expensive CGM that has been available in the market in the past couple of months, people are buying it on their own. You don’t need to go through an insurance company, so it’s very easily accessible. Or you talk to your friends or coworkers that are in the European countries or outside the US, where the device has been available basically by going to a drugstore, picking it up. So, people have gotten this and are using this irrespective of whether they’re insulin users or pill users. And I think it goes really to show how universally applicable we all feel this tool is. I actually happen to give a presentation to a community in our state, it’s an Indian community, that feel so strongly about this that they’re going to make the most recent sensor available to every type 2 individual in their particular community. And in speaking to one of my older senior citizens about this, and it’s a person who is on insulin but lives in a senior housing and we’ve talked about this. And he said, “Oh, that patch one? I can’t tell you how many people are around that congregate dining table that show me their patch. I know all about it. You don’t need to tell me anything about this. I know how to use this. Just give me the prescription for this.” (Laugh) So, I think that eventually it will become a tool that really will replace finger-sticks completely, just like finger-sticks replaced urine.

Freed: What are the barriers to the CGM sensor?

Trence: Right now? Well, one of the major barriers is expense because not all of them are inexpensive by any means and still require some insurance coverage for people that want to use it on an ongoing basis. I think that will change over time. I think the other big issue is the accuracy issue. They’re getting better and better, and better, and better. Are they prefect? Are they as accurate as we would like in all conditions? Not maybe quite yet, but it’s coming. And I think the last part is that many of them still require calibration. Again, that’s changing to where there will be no calibration or at least not the need to do finger-sticks unless something is odd. As I tell some of my patients that I see or if you see that that says your blood sugar [is] 500, you say, “(Laughs) I don’t think so. I don’t feel like I’m at 500.” Well, we still need the finger-stick to kind of calibrate or corroborate if you want to say that this is really the glucose that it should be at.

Freed: What needs have CGM shown us that were not recognized previously?

Trence: Well, I think certainly the ability to respond to someone immediately. I mean, CGM tells you, “I just did this and I got this result in my blood sugar.” So, how can I approach this? How can I do better? And I think one of the things that we’re recognizing is that we need the ability to respond very quickly to situations. Not wait until the appointment in a week or a month or three months when totally forgotten like, “What was it that I did?” I think we need to be able to get tools that allows the ability to really respond much, much more promptly to issues that require some kind of a discourse between the clinician and the patient. 

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