Is CGM Having Its Moment? Continuous Glucose Monitoring (CGM) Took Center Stage at ADA Scientific Sessions 2023
The annual American Diabetes Association (ADA) Scientific Sessions serve as an important platform to unveil groundbreaking advancements in diabetes research and management. At the 2023 ADA Scientific Sessions, the significance of Continuous Glucose Monitoring (CGM) took center stage in many of the presentations and on the Expo floor, yet CGM is not a new technology. Are we seeing CGM have its moment in the spotlight as evidence of the impact of CGM on clinical care matures and insurance coverage expands? There were presentations on CGM adoption, advocacy for broader adoption, studies on the impact in special populations, and talks about tools for CGM-based population health approaches to diabetes management. The following are highlights from presentations I most enjoyed on CGM at ADA this year!
Current and Future State of CGM
Kelly Close of Close Concerns began her presentation, Time-in-Range from a Patient Perspective, with a helpful perspective on where we are in the growth curve of CGM adoption. There are an estimated 6.7 million CGM users globally, an eight-fold increase from 2017. That’s huge growth, but with 70 million people globally on insulin therapy, there’s a lot of room to grow! And it is not just people on insulin, according to the 2023 ADA Standards of Care, any person on insulin or sulfonylureas may be good candidates for CGM due to risk of hypoglycemia.
Following Medicare’s expansion of coverage for CGM to all people with type 2 diabetes on insulin, we should expect further adoption of CGM in people with type 2 diabetes. By in large, expanded coverage for CGM and incorporation into the Standards of Care for more patients is being driven by outcomes such as this: Every 5% decrease in Time in Target Range equates to a 16% increase in the relative risk of developing diabetic retinopathy according to the Barbara Davis Center. The better we can measure glucose, the better we can manage it! How to do that across a growing population of patients? More on that later.
Empowering Underserved Populations
The availability and accessibility of diabetes care and management tools remain a challenge for medically underserved populations, including those in low-income communities or remote areas. Medicaid coverage for CGM is inconsistent on a state-by-state basis.
CGM technology has the potential to bridge this gap, ensuring that all individuals, regardless of their socioeconomic status, can benefit from continuous glucose monitoring. Its non-invasive nature and ease of use make CGM devices suitable for individuals with limited healthcare resources or diabetes education.
The ADA Scientific Sessions 2023 highlighted studies showcasing the positive impact of CGM on underserved populations, where it significantly improved glucose control and reduced the risk of diabetes-related complications. One example was a poster presented by Carilion Clinic and shown below about a pilot study in which they implemented CGM with multidisciplinary teams and were able to achieve a significant reduction in hemoglobin A1c (11.8% to 7.9%) in a three-month period with limited resources.
Yale University SOM and Nuvance Health presented a Quality Improvement project in which they deployed CGM in a population with type 2 diabetes at a Federally Qualified Health Center. This study showed positive impacts on hemoglobin A1c reduction as well as reduction of hypoglycemia while also giving providers the confidence to be more aggressive about medication adjustments and to overcome clinical inertia using CGM data. Can deploying CGM help democratize diabetes care in a system that today we know to be inequitable?
A consistent theme in these demonstrations and quality improvement projects is scalability. With both nursing and physician shortages straining a system already challenged by access issues, everyone is looking for models of care that allow for maximal impact with limited resources.
New Tools for CGM Management
The evolution of CGM technology has not only provided more affordable and accurate continuous glucose monitoring devices but has also introduced new tools that enhance how clinicians use the data. These analytics and tools are key to addressing the scalability issue highlighted above. If care teams are to efficiently and effectively manage populations of patients on CGM, we need standardized metrics that can be applied to triage and prioritize patient care and to drive clinical decision support systems.
Time in Range (TIR) is a key metric that measures the amount of time spent within target glucose ranges, offering a broader perspective on glycemic control. By focusing on TIR, healthcare providers can assess the effectiveness of treatment plans and make necessary adjustments to improve outcomes. TIR has grown in adoption as more clinicians use the Ambulatory Glucose Profiles that are standardized across CGM platforms and present TIR data in a consistent form.
Dr. Daniel DeSalvo from Texas Childrens presented the potential positive impact TIR can have on clinical care as well as the challenges of using TIR in clinical practice. Given the challenges places on providers to review large data sets, Dr Daniel DeSalvo from Texas Childrens presented the potential positive impact TIR can have on clinical care as well as the challenges of using TIR in clinical practice. Given the challenges placed on providers to review large data sets, clinical decision support and population health tools are needed to help streamline workflows.
The Glycemic Risk Index (GRI) is an emerging tool that received some coverage at the ADA Scientific Sessions 2023. GRI evaluates the risk of hypoglycemia and hyperglycemia, not just TIR, aiding healthcare professionals in identifying individuals at higher risk and implementing preventive measures.
Rimidi's Platform Enhancements Support Evolution in Diabetes Management
Rimidi recently announced the incorporation of GRI into our diabetes management platform as a tool for population stratification and clinical decision making. Additionally, the integration of Clinical Decision Support (CDS) systems with CGM data within the Rimidi platform allows for real-time analysis, personalized recommendations, and alerts, empowering both patients and healthcare providers to make informed decisions about diabetes management.
