Posted by Bill Sandweg on 03 May 2021.
The latest marketing campaign directed at Type 2 diabetics is intended to sell them continuous glucose monitors (CGM’s). Since there are estimated to be over 30 million Americans with Type 2 diabetes, there are a lot of potential customers.
For those with Type 1 diabetes, glucose monitoring is a matter of life and death. They are not able to make any insulin on their own and must frequently test their blood to know how much insulin to give themselves to keep their glucose levels in a proper range. Too high a glucose level over a long period of time will result in permanent injuries, including diabetic retinopathy and diabetic peripheral neuropathies. Blindness and limb amputations may follow. If blood glucose gets too low, even for a short period of time, it can cause the patient to lose consciousness, to go into a diabetic coma and even to die.
Type 2 diabetics, on the other hand, still make some insulin. Generally speaking, however, their bodies don’t react to it as well as do persons without diabetes. Their blood glucose levels tend to spike after eating and then decline. Some Type 2’s even have to give themselves supplemental insulin as their bodies do not make enough.
The old fashioned way of checking blood glucose levels is through the use of a finger stick. A drop of blood is then placed on the end of a test strip. The other end of the strip is inserted into a device, which analyzes the blood and displays the blood glucose level in a window. This is the gold standard and is extremely reliable.
Continuous glucose monitors, on the other hand, have a small probe, which is inserted into the patient’s body, often into the upper arm or the abdomen. It senses, not the blood glucose level itself, but a closely related level of glucose in the fluid between the cells. The glucose between the cells lags behind blood glucose and is usually somewhat different from it. When blood glucose is on the rise, the interstitial glucose will be lower than the blood glucose. The faster blood glucose is rising, the greater the gap. When blood glucose is dropping, the interstitial level will again lag behind but now will be higher than blood glucose.
Type 2 diabetics do not need to check their glucose levels multiple times a day, as do Type 1 diabetics. Since their bodies are making some insulin, they only need a general idea of how they are doing. They should check their blood glucose at least once a day and adjust their diet and activity levels accordingly. Those Type 2 diabetics who must give themselves insulin may need to check blood glucose more often.
The problem with continuous glucose monitors is primarily one of cost. Testing actual blood glucose through a finger stick costs around a dollar a day. Continuous glucose monitors, on the other hand, are expensive. It is reported that, without insurance, the annual cost of a CGM is between $1,000 and $3,000. New models, however, are coming on the market that bring the cost way down. These are being marketed heavily on television.
This is another example of expensive technology or expensive medication being marketed directly to patients, who may not really need it and who are in no position to truly judge the merits of the product. When we wonder why we spend so much on health care and get so little for it in return, the marketing of CGM’s should come to mind. One thing you have to say for it is that the drug and device industry knows its market and is ruthlessly successful in pushing its message.