Friday, April 22, 2011

Cool Gizmo Machine AKA CGM

"Meet Mr. CGM Man!"
I am really wanting to initiate some serious CGM (Continuous Glucose Sensor) sensing in da house full of Diabetics.  My drawbacks were financial, basically couldn't afford the 200 for 4 sensor equation. But we now have a "Flex Account" meaning, I could, if I wanted to, get them covered. Hence my new dilemma.

The new barrier is not the cost, but the size of the Medtronic Sensors.  They could be used to hang up the cork board in my kitchen. Seriously, that BIG!  So I did some research to try to sway me into making a decision. Just Skim it. Thought since I read it I might as well share it!


My Take: 

Battelino and crew took 120 people with type 1 DM. (Randomly - which makes the study better) split them in half, one control group, one treatment group. They followed the groups for six months and concluded the following:

“In conclusion, the results of the current study demonstrated significantly shorter time spent in hypoglycemia in children and adults with type 1 diabetes who used continuous glucose monitoring compared with standard SMBG, with a concomitant significant decrease of HbA1c.”

In a nutshell:

CGM is a good way to stay out of the hypo zone.   It also has an effect on over all control shown by a lower A1C.

 Here is very informative article discussing some “don’ts” with RT-CGM(Real Time CGM) use and insulin pumping, written by Howard A. Wolpret, MD.

Here is the Link to the Article Titled; The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  Here is the Article Link  Lots of cool graphs, talks about things like not shutting the basal off to treat lows, and not pre-maturely bolusing for highs. Good stuff!

Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  The authors randomly assigned 272 PWD to use CGM over a period of six months.  This is what they found:

“After 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near daily CGM use is associated with a similar reduction in A1C."

Once again the results show that there is a benefit from frequent use of CGM for PWD of all ages.

"MedTronic"
I think there’s a trend here.  Well on a personal note;  in our house full of diabetics  we are the proud owners of  two insulin Pumps with CGM capabilities.  We own one sensor (2800 bucks) and we don’t currently use it. For the aforementioned reasons.

"The Dex"
Unfortunately the Dexcom CGM isn’t available in Canada(I hear from the DOC that it's mucho better) and I have yet to hear anything back from my numerous emails writtem to the company.  I love my Medtronic Pump, and the built in Sensor thingy, but the needle is ginormous! Like Hammer and Nail large.  I can barely stomach it let alone my wee one.


If anyone reads this and knows anything about the Dex and when it is going to immigrate to Canada, please keep my clan posted. 

Trev



Sources: 
Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  Factors Predicative of Use and of Benefit from Continuous Blood Glucose Monitoring in Type 1 Diabetes. Diabetes Care 32:1947–1953, 2009.
http://care.diabetesjournals.org/content/32/11/1947.full.pdf+html?sid=4c7cc395-3b1b-48c1-b381-6a43aa732cd5

Tadez Battelino, MD, PHD, Moshe Phillip, MD, Natasa Bratina, MD, PHD, Revital Nimiri MD, Per Oskarsson, MD, PHD, Jan  Bolinder, MD, PHD. The Effect of Continuous Blood Glucose Monitoring on Hypoglycemia in Type 1 Diabetes.
Diabetes Care 34:795–800, 2011

Howard A. Wolfert MD.  The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  http://care.diabetesjournals.org/content/31/Supplement_2/S146.full.pdf+html?sid=21e0bbe2-9439-45b6-825b-69b69aca3cc3


4 comments:

Erin said...

I have no inside info on when the Dex is going to be available in Canada (sorry), but I just started using it and I love it. I tried out the Medtronic one a few years ago, and didn't like it nearly as much. All that being said, since your wee one can't feel her lows, it might be worth using it for her, even if it's not quite as good as the Dex. Good luck with your decision, though!

Jonah said...

I thought the enlite sensors for medtronic were supposed to come out sometime really soon and be smaller.

Having worn both systems, if it's any consolation, I think the sensor is the only part of the system that dex does better on- Minimed has some cool data crunching features and it will convert mg/dl to mmol for you and it will let you run it in lots of languages.

Reyna said...

No information for ya Trev...but I do love me some "Dexter" (the Dexcom).

I just like commenting over here b/c I can again!!! WOHOOOOOOOOOO!!!

Have a great day.

Sarah said...

The enlite sensors from MM are about two years away due to a programming incompability with the current pump (the current pump has a 3 day max for sensors where as the enlite is a 7 day sensor).
I think I have told you before that Isaac uses it for about one week a month, we have a booty load of sensors but just one transmitter. My folks were kind enough to help offset the cost as our insurance didn't fully cover it. I have found it invaluable in terms of seeing trends and therefor making future decisions on basals, ISF and I:C ratios for Isaac. Also, he doesn't mind the insertion or the size of it, he gets more irritated when it beeps when he's having fun. I'd give it a go for a while and see how she likes it. Sadly I'll also admit we bribe him to sit still for the ginormous needle with a short video of his choice on youtube (usually monster trucks!).
Wish I had more info about the dex, but I personally am to freaked out about how many times I've heard of the wire breaking off in patients...and they're coming out with a new one soon.