ADA 2019—Promising effects of intermittently scanned “flash” CGMs


  • International Clinical Digest
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The following is the transcript from an  onsite interview  with Dr. Neil Skolnik and Dr. Pablo Mora at the 79th American Diabetes Association Scientific Sessions held June 7-11, 2019 in San Francisco, California. The transcript has been edited for clarity.

 

Neil Skolnik, MD: I’m Dr. Neil Skolnik at the 79th American Diabetes Association Scientific Sessions where we just heard a wonderful set of discussions on glucose monitoring that was chaired by Dr. Pablo Mora, an investigator at the Dallas Diabetes Research Center, and Professor of Medicine at the University of Texas Southwest Medical Center, in Dallas. Welcome, Dr. Mora.

 

Pablo F. Mora, MD, FACE, MsSc, CDE: Thank you, Neil. This is a great opportunity to present some of the data to your audience. As you know, continuous glucose monitoring is a technology that has revolutionized the way that we interact with our patients. I want to remind your audience that we now have 2 types of technologies to be aware of.

 

Both are called CGM, but they are based on 2 different approaches. One gives real-time continuous measurements every 5 minutes, which is probably most useful for type 1 diabetes, where patients need multiple daily injections. However, I think that your audience will become more familiar with the intermittently scanned data, what we call “flash” monitoring. These 2 systems are very useful and were the focus of the data we presented today in our symposium.

 

Skolnik: That’s helpful. And flash glucose monitoring, brand name FreeStyle Libre, is out there now, and it may not be something we have become familiar with in primary care. But, when I walked into Walmart last week, I saw an advertisement for it. So, it’s something that we better become familiar with. Will you tell us a little bit about what was gone over in the symposium?

 

Mora: Yes. This system basically has been on the market for more than a year-and-a-half. One of its great benefits is that it takes fingerstick testing out of the equation because it doesn’t require calibration. And the second thing that is very useful is that the automatic insertion is very fast, so the patient doesn’t have to be trained or have any specific dexterity to use it. So, the future of glucose monitoring in diabetes is actually without capillary testing.

 

Skolnik: That’s an amazing advancement for both patient comfort and satisfaction, and with the amount of information that we get from these devices.

 

Mora: Absolutely. And now the provider as well as the patient has access to the data all the time, either on a receiver or on an app on their phone. At any given time, this information can be used to make therapeutic decisions and better plan the day. We are now in a time when the patient is taking more control of their own information.

 

Skolnik: I’ve noticed that patients are now seeing the effect of dietary choices on their data in a way that was harder to detect with just intermittent glucose fingersticks.

 

Mora: Right, and patients are now taking the liberty to test themselves. “What happens if I have this piece of bread or this piece of pizza?” They would never have done that before with a fingerstick. But now, they can see the effect and they can make behavioral changes based on that information.

 

Skolnik: So, they can make behavioral changes based on the information they see. Will you talk more about the effect of flash glucose monitoring that was covered in the meeting?

 

Mora: There were 10 abstracts altogether, but 2 of the abstracts deal with something that I think your audience will find very intriguing. Number 1, will these behavior changes last? And the answer is yes. If you follow these patients for 1 or 2 years, you see that the changes in the behavior lead to changes in HbA1c and, also, quality of life. We want changes for the long run, so those 2 things are very important.

 

Skolnik: Is there a sense of the amount of improvement in the HbA1c that one can hope to get with using this sort of monitoring?

 

Mora: It’s very hard to dissect exactly how much of the outcome was from the sensor component of this device. But, in general, we can expect a range of a 0.5%-0.9% reduction in HbA1c, which, as you know, has a clinically significant impact on chronic complications.

 

Skolnik: It’s significant for chronic complications. It’s also what you sometimes get when you add another medicine to someone’s regimen, but this improvement was achieved from information providing the impetus for behavioral change.

 

Mora: The other thing that is important for your audience to take away from this is that the interventions in this case simplify the patient’s life, instead of making it more complex. So, it’s almost like getting more by doing less.

 

Skolnik: I love that. Dr. Mora, thank you so much for taking the time to talk to us about the event that you chaired. For Univadis, I’m Dr. Neil Skolnik at the 79th American Diabetes Association Scientific Sessions. Thank you for listening.

 

Neil Skolnik, MD is a Professor of Family and Community Medicine at Sidney Kimmel Medical College, Thomas Jefferson University, and Associate Director of the Family Medicine Residency Program at Abington-Jefferson Health.

Pablo F. Mora, MD, FACE, MsSc, CDE is an Endocrinologist at Dallas Diabetes and Endocrine Center at Medical City Dallas, and Professor of Medicine at the University of Texas Southwest Medical Center. 

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