March 2019

The potential value of continuous monitoring of blood glucose and the enzyme-based electrode that underlies continuous glucose monitoring (CGM) in the subcutaneous tissue were described in the 1960s. In 1999, the FDA approved the first “professional” CGM system, which stored data over 3 days for later retrieval and analysis. However, many patients (even volunteers in CGM-based clinical trials) found early-generation systems uncomfortable and difficult to wear. By contrast, current systems are more accurate, provide customizable alerts and alarms, are easier to use and less likely to cause skin irritation, resist interference from acetaminophen, allow for real-time data to be shared and remotely monitored, and are stable enough so as not to require periodic calibrations with SMBG values.

Continuous glucose monitors (CGMs) are increasingly accessible and effective for patients with type 2 diabetes (T2D), and even those with prediabetes, as a means for real-time biofeedback and behavior change.

When the FDA approved Abbott’s FreeStyle Libre Flash continuous glucose monitoring (CGM) system in September 2017, diabetes advocates hailed the move as long overdue and one that might lead to greater penetration of glucose monitoring technology for those with type 2 diabetes.

Increased transparency, value-based pricing, and other policy reforms are necessary to ensure that Americans can access medications at affordable prices, a panel of experts said during a US Senate hearing January 29, 2019.

In 2017, as advocates and researchers discussed the potential for continuous glucose monitoring (CGM) to become a tool in clinical trials, most of the discussion involved testing in new therapies. The discussion culminated in an international consensus on CGM, published in December 2017, that included standards for assessing hypoglycemia in clinical trials.

Nearly 3 years after UnitedHealthcare set off a firestorm among the type 1 diabetes (T1D) community by naming Medtronic its preferred supplier of insulin pumps for adults, a fresh wave of protest has erupted after the payer extended the pact to youth, starting at age 7. The change was announced in a UnitedHealthcare bulletin February 1, 2019.

Even when things go well, managing diabetes is not easy. Keeping tabs on this disease 24/7 takes planning, commitment, support, and the right tools. For years, a chief complaint among those living with diabetes has been that managed care nickel-and-dimes people over basic supplies, which are comparatively cheap—things like test strips and sensors for a continuous glucose monitor—but will shell out thousands for dialysis and amputations. In the years ahead, if Congress wants to understand rising costs for end-stage renal disease or an increase in emergency department visits for hypoglycemia, it should look directly to CMS’ foray into competitive bidding for blood glucose test strips.

Three years after results from a study in Diabetes Care revealed how flaws in CMS’ Competitive Bidding Program endangered Medicare patients who rely on supplies to test their blood glucose, the federal government has allowed contracts to expire for the dwindling number of suppliers, raising fears that the program for seniors with diabetes has reached the point of collapse.