One significant finding in the recent VA Diabetes Trial was that recent severe hypoglycemia was a pwerful predictor of cardiovascular events. During the recent ADA meetings, one member of the expert panel discussing the results of the ACCORD trial suggested that the excess mortality in the intensive glycemic control group was likely due, at least in part, to hypoglycemia. The authors were not able to demonstrate this by analyzing their data. Another member of the panel pointed out that significant hypoglycemia found on CGM is often asymptomatic.
What is your experience with CGM? In which clinical scenarios have you found it to be useful? Maybe you have decided that it has no role in your practice. Let's discuss this.
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I started using the Minimed CGM about three months ago (I also use the Minimed Paradigm 722 insulin pump). When I began using it, my A1c was 7.8. Today, it is 6.1. I have no doubt that this significant drop is due to the data provided by the CGM.
I think the greatest benefit from the CGM is that it has helped me nail down my basal rates, especially overnight. I had done nighttime basal checks many times, but the simple act of waking up and testing tending to skew the results. Since the CGM is always on, I can sleep through the night and view the results in the morning.
It’s also saved me from a few really bad lows. The tighter control I have, the less likely I am to recognize hypoglycemia, so the CGM gives me a nice, loud alarm when I drop below 80 (which in the real world means I’m about 65).
The mistake that most people make (and probably the leading cause of frustration) is thinking that the CGM can replace finger sticks. I actually test *more* that I did before getting the CGM. I know that its purpose is to identify trends and make informed decisions. I have never used it to determine a bolus – I always use a finger stick for that.
My insurance doesn’t pay any portion of the CGM costs. I purchased the transmitter, sensors, etc. out-of-pocket because I felt the benefit would worth the cost. I can honestly say that it is. Hopefully, more insurance companies will recognize that the costs of covering a CGM are cheaper than treating diabetes complications down the road.
If you have specific questions, I’d be happy to provide any additional information that might be helpful.
It is due to the kindness of someone I am able to wear the Minilink CGMS. I am on CalOPTIMA, and of course we don't get the frills that others on private insurance may get.
I do not see well because of retinopathy of prematurity, so I can't drive. Just having this on me has saved me from a few lows while out by myself. I don't feel so vulnerable anymore about "What would happen if I conk out on the street?" It's a scary thought for anyone really...
I was going to use my economic stimulus pack to get a bill out of the way, but I thought differently and bought sensors for the CGMS instead. I am currently trying to afford one of my own, so I picked up extra hours at work. AH.... Work.... That's another place where this thing has saved my bacon. It was alarming one day in the store and I was at 62 mg/dL according to it, but checking on my meter, I was at 54!
I doubt I'd be working if I start doing imitations of Michael Jackson on the floor in a severe low. CGMS is so worth it, and yes, I too check bg's more diligently with it than without it.
I am currently trying to get my insurance (PEHP of Utah) to cover a CGMS. I am not having great luck so far. I was on a CGMS for 3days and I was very impressed with how much it actually helped me in that short amount of time.
I have had lows before that caused me two car accidents. Luckily, I lived to talk about these incidents. I have had nighttime lows where I have needed the assistance of my husband to get through them. I have had one time where a couple of co-workers helped me through a day time episode of hypoglycemia. What would it take to get me coverage? Accidentally killing someone or myself? Having to be hospitalized? I just have to wonder. I feel it is ridiculous to have insurance companies act like they are God (or like they are my doctor and know what is BEST for me!!)
I have been Type 1 for 31 years. I have no retina or renal issues at all, thank god. I have low cholesteral and BP. Lucky genes I guess except for the diabetes. I started using the DexCom Seven CGM over a year ago after suffering repeated bouts of hypoglycemia. I suffer Hypoglycemia Unawareness. My A1C has always been between 6.5 and 7.5 but the hypo attacks were going to eventually do me in. I have Kaiser insurance who denied coverage in spite of appeals and letters from my endo.So I bought the CGM and have been using it since. I have had a few minor hypos but none that required medical attention. Everyone I know is amazed on how I rarely suffer lows. It is not perfect and I don't rely on the CGM alone for control but it has been a miracle in regards to preventing hypos. Kaiser still won't cover it in spite of their savings in ambulance and ER visits but I will manage to pay for it. This is such an important tool yet why do may insurers refuse to cover it?
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