A study that resolved the dilemma | Who funded the study and why it matters | What do other experts say | Other monitoring benefits
Which technology will better improve compensation and quality of life: an insulin pump or continuous glucose monitor (CGM)? Although the combined use of the two technologies has amazing potential, the sad truth is that many people cannot afford two expensive devices at once. Then the question is – where to start?
Combined use of the two technologies has amazing potential
This is a matter that has been thoroughly researched and discussed by doctors and scientists. And it seems that experts are beginning to agree: if you had to choose only one device, it is better to resort to CGM.
This consensus is important news, and not only for patients who want to optimize their glycemic control. It is important to pay attention to doctors (who directly work with patients), and also to take into account in the planning of state medical campaigns.
A study that resolved the dilemma
A three-year study was published in the latest edition of Diabetes Care. Researchers followed approximately 100 participants divided into four different groups: a pump with CGM, a pump without CGM, multiple daily injections (syringe pens) with CGM, multiple daily injections (syringe pens) without CGM.
Patients who used CGM showed significantly lower levels of glycated hemoglobin
Patients who used CGM showed significantly lower levels of glycated hemoglobin (Hemoglobin A1C). In addition, these same groups showed a lower incidence of hypoglycemia compared to those who checked their blood sugar with a glucometer. What surprised researchers was that these improvements were comparable between groups that used CGM with and without an insulin pump. That is, the method of insulin delivery was insignificant.
Who funded the study and why it matters
The COMISAIR study was partly funded by Dexcom, so some readers may be skeptical of these findings. Although you should be wary of science supported by industry, in this case I think that the interests of Dexcom more or less coincide with the interests of people with diabetes.
It is worth noting that the clients of Dexcom and the target audience in the study were not patients, but insurers, due to the structure of the healthcare system in many countries where the technology is used. The authors of the COMISAIR study clearly named “payers” to emphasize the cost savings associated with better glycemic control.
What do other experts say
Meanwhile, in the August issue of Current Diabetes Reports, a group of American endocrinologists ask the question more directly: “what should come first: an insulin pump or a continuous glucose monitor?” Their conclusion is unconditional. After reviewing recent clinical trials and addressing practical issues such as cost and quality of life, the authors finally recommend CGM as a “first-line technology”.
This review examined a larger number of studies, the results of which boil down to approximately the same conclusion: people using CGM technology invariably spent less time in a hypoglycemic state and usually also had lower levels of GH. Insulin pumps did not show such benefits compared to using multiple daily injections. Some studies examined participants using only CGM or only an insulin pump, and all concluded that CGM provides excellent control of blood sugar levels.
Other monitoring benefits
Other factors also seem to contribute to CGM. Compared to an insulin pump, CGM usually requires less preparation and training. This means that monitoring is much easier to integrate into everyday life and in the diabetes compensation regimen.
In addition, protection against hypoglycemia reduces emotional stress, improving the quality of life.
Also, CGM is often cheaper, given the usually high cost of the insulin pump itself. The monthly costs of Dexcom and Freestyle devices are more or less competitive with some of the leading insulin pumps, but they do not require the same upfront costs.
Real-time glucose measurements allow to tune daily glucose management more accurately
It seems almost obvious that having reliable real-time glucose measurements would allow people with diabetes to more accurately tune their daily glucose management. But it is worth remembering that the early CGM models were relatively inaccurate. Only in recent years, with the introduction of Freestyle Libre and Dexcom G5 and G6 systems, patients have enthusiastically accepted this technology. One of the great aspects of the COMISAIR study was a very high level of commitment: the study participants in the vast majority of cases continued to use CGM for all three years of the study.
CGM manufacturers really want their technology to be recognized as the “treatment standard” for people with type 1 diabetes (and possibly type 2). These recent studies reinforce the position of CGM, which could potentially make the technology more accessible and widely applicable.