What can CGM's provide for individuals who don't have diabetes?
Continuous glucose monitors (CGMs) have greatly improved outcomes for individuals with diabetes, and now, they are increasingly being used by people without diabetes, according to Vijaya Surampudi, MD, an endocrinologist and assistant professor of medicine in the Division of Human Nutrition at UCLA Health in Los Angeles, California, and assistant director of the UCLA Weight Management program. Drug Topics recently spoke with Surampudi about CGM advancements and pitfalls.
Drug Topics: CGM technology has advanced rapidly in recent years. What are you most excited about and what are some of the new technologies that are helping improve outcomes?
Vijaya Sarampudi, MD: CGMs are becoming increasingly popular, and data show that they can impact a wide range of diabetes outcomes, including glucose levels and HbA1c, reduced complications like severe hypoglycemia or diabetic ketoacidosis, and quality of life factors which are often overlooked. The CGM is actually the first step towards a closed loop control or an artificial pancreas. The artificial pancreas technology would link to the CGM to automatically control insulin delivery.
With CGM use becoming more widespread, it has really prompted the development of mobile technology, and the connection to mobile devices has facilitated ongoing improvements in self-care and communication of data. In addition, it has even developed new metrics of glucose control [such as] time in range (TIR), which has garnered much attention. Regarded as a helpful supplement to HbA1C, it’s able to illuminate how factors like food, exercise, or sleep affect your glucose levels day-to-day.
Drug Topics: You have said that many individuals without diabetes are starting to utilize CGMs? Why are we seeing this as a trend, and for what conditions? Do you generally recommend this?
Sarampudi: I think it is really helpful in the setting of insulin resistance in general. So, for people who have metabolic syndrome or prediabetes…or even just 1 risk factor for insulin resistance, it can help us understand how factors like food, exercise, or sleep affect your glucose levels day-to-day.
We never know how people are going to react to different foods, so wearing a CGM can help guide them with their choices. Everyone says oatmeal is great, but for some people, they eat oatmeal and their HbA1c level shoots up over 200 mg/dL. With a CGM, they can identify that and recognize that oatmeal is perhaps not the best food for them.
The goal [that we are] striving for is prevention and personalized approaches to medicine, and the CGM is able to provide both of these to patients with relative ease. This is one of the tools
we have to personalize advice because each body is different and how they respond to stress or food can vary.
Drug Topics: How should pharmacists guide patients on the best ways to utilize CGMs?
Sarampudi: I think reminding them that this is more than just a glucose monitoring tool; they have the ability to give us feedback on our lifestyles [which is important]. I have had patients notice that stress itself—without even eating—will significantly raise their blood glucose. This can then help evaluate, “Do we have the best coping tools for stress?”
Drug Topics: What are the challenges with CGM technology? What do patients most often have issues with?
Sarampudi: Because [CGMs] measure the interstitial glucose, they sometimes may not be as reliable. Blood glucose levels can be measured with a high reliability—something that is more difficult with interstitial fluid and the glucose levels often lag behind the blood glucose levels. Watching the trend on the CGM is important; if the levels are going down fast, the blood glucose might be even lower.
Other issues are sometimes positioning can affect the sensor reads and how someone sleeps on the sensor can falsely give low glucose alerts. Additionally, sometimes data overload can be overwhelming for some people. Some don’t know what to do with all the information.