2B
Saturday, March 20, 2021
The Observer & Baker City Herald
MONITORS WORN ON BELLY OR ARM ALLEVIATE NEED FOR PATIENTS TO PRICK THEIR FINGERS
Constant glucose monitors show little benefit
Phil Galewitz
Kaiser Health News
In the nation’s battle against the
diabetes epidemic, the go-to weapon
being aggressively promoted to
patients is as small as a quarter and
worn on the belly or arm.
A continuous glucose monitor
holds a tiny sensor that’s inserted
just under the skin, alleviating the
need for patients to prick their fi n-
gers every day to check blood sugar.
The monitor tracks glucose levels all
the time, sends readings to patients’
cellphone and doctor, and alerts
patients when readings are headed
too high or too low.
Nearly 2 million people with dia-
betes wear the monitors today, twice
the number in 2019, according to the
investment fi rm Baird.
There’s little evidence continuous
glucose monitoring (CGM) leads to
better outcomes for most people with
diabetes — the estimated 25 million
U.S. patients with Type 2 disease
who don’t inject insulin to regulate
their blood sugar, health experts say.
Still, manufacturers, as well as some
physicians and insurers, say the
devices help patients control their
diabetes by providing near-instant
feedback to change diet and exercise
compared with once-a-day fi nger-
stick tests. And they say that can
reduce costly complications of the
disease, such as heart attacks and
strokes.
Continuous glucose monitors are
not cost-effective for Type 2 diabetes
patients who do not use insulin, said
Dr. Silvio Inzucchi, director of the
Yale Diabetes Center.
Sure, it’s easier to pop a device
onto the arm once every two weeks
than do multiple fi nger sticks, which
cost less than a $1 a day, he said.
But “the price point for these devices
is not justifi able for routine use for
the average person with Type 2
diabetes.”
Without insurance, the annual
cost of using a continuous glucose
monitor ranges from nearly $1,000
to $3,000.
Lynne Shallcross/Kaiser Health News-TNS
Trevis Hall, of Fort Washington, Maryland, credits a continuous
glucose monitor with helping him get his diabetes under control.
Makers of the device say that instant feedback provides a way to
motivate healthier eating and exercise. But experts point out that the
few studies on the monitors show confl icting results.
people with Type 2 disease is called
hemoglobin A1c, which measures
average blood glucose levels over
long periods of time. Neither fi nger-
prick tests nor glucose monitors look
at A1c. They can’t since this test
involves a larger amount of blood
and must be done in a lab.
The continuous glucose moni-
tors also don’t assess blood glucose.
— Dr. Katrina Donahue, University
Instead they measure the intersti-
of North Carolina Department of
tial glucose level, which is the sugar
Family Medicine
level found in the fl uid between the
cells.
a pump or syringe. Because insulin
Companies seem determined to
injections can cause life-threatening sell the monitors to people with Type
drops in their blood sugar, the devic- 2 diabetes — those who inject insu-
es also provide a warning to patients lin and those who don’t — because
when this is happening, particularly it’s a market of more than 30 million
helpful while sleeping.
people. In contrast, about 1.6 million
People with Type 2 diabetes, a
people have Type 1 diabetes.
different disease, do make insulin
Helping to fuel the uptake in
to control the upswings after eat-
demand for the monitors has been
ing, but their bodies don’t respond
a drop in prices. The Abbott Free-
as vigorously as people without
Style Libre, one of the leading and
the disease. About 20% of Type 2
lowest-priced brands, costs $70 for
patients still inject insulin because
the device and about $75 a month
their bodies don’t make enough and for sensors, which must be replaced
oral medications can’t control their
every two weeks.
diabetes.
Another factor has been the ex-
Doctors often recommend that
pansion in insurance coverage.
diabetes patients test their glucose
Nearly all insurers cover continu-
Lower prices help propel use
at home to track whether they are
ous glucose monitors for people with
People with Type I diabetes —
reaching treatment goals and learn Type 1 diabetes, for whom it’s a
who make no insulin — need the
how medications, diet, exercise and proven lifesaver. Today, nearly half
frequent data from the monitors in stress affect blood sugar levels.
of people with Type 1 diabetes use a
order to inject the proper dose of a
The crucial blood test doctors use, monitor, according to Baird.
synthetic version of the hormone, via however, to monitor diabetes for
A small but growing number of
“I don’t see the extra value
with CGM (continuous glucose
monitoring) in this population
with the current evidence
we have. I’m not sure if more
technology is the right answer
for most patients”
insurers are beginning to cover the
device for some Type 2 patients who
don’t use insulin, including Unit-
edHealthcare and Maryland-based
CareFirst BlueCross BlueShield.
These insurers say they have seen
initial success among members us-
ing the monitors along with health
coaches to help keep their diabetes
under control.
The few studies — mostly small
and paid for by device-makers — ex-
amining the impact of the monitors
on patient’s health show confl icting
results in lowering hemoglobin A1c.
Still, Inzucchi said, the monitors
have helped some of his patients
who don’t require insulin — and
don’t like to prick their fi ngers —
change their diets and lower their
glucose levels. Doctors said they’ve
seen no proof that the readings get
patients to make lasting changes
in their diet and exercise routines.
They said many patients who don’t
use insulin may be better off taking
a diabetes education class, joining a
gym or seeing a nutritionist.
“I don’t see the extra value with
CGM in this population with cur-
rent evidence we have,” said Dr. Ka-
trina Donahue, director of research
at the University of North Carolina
Department of Family Medicine.
“I’m not sure if more technology is
the right answer for most patients.”
Donahue was co-author of a land-
mark 2017 study in JAMA Internal
Medicine that showed no benefi t
to lowering hemoglobin A1c after
one year regularly checking glucose
levels through fi nger-stick testing
for people with Type 2 diabetes.
She presumes the measurements
did little to change patients’ eating
and exercise habits over the long
term — which is probably also true
of continuous glucose monitors.
“We need to be judicious how we
use CGM,” said Veronica Brady, a
certifi ed diabetes educator at the
University of Texas Health Science
Center and spokesperson for the
Association of Diabetes Care &
Education Specialists. The monitors
make sense if used for a few weeks
when people are changing medica-
tions that can affect their blood
sugar levels, she said, or for people
who don’t have the dexterity to do
fi nger-stick tests.
Yet, some patients like Trevis
Death rates from strokes rising
among middle-aged rural residents
■ Research shows stroke deaths rose 2% for ages 35-64 in rural counties over 5 years
Hall credit the monitors for help-
ing them get their disease under
control.
Last year, Hall’s health plan,
UnitedHealthcare, gave him a mon-
itor at no cost as part of a program
to help control his diabetes. He said
it doesn’t hurt when he attaches the
monitor to his belly twice a month.
The data showed Hall, 53, of Fort
Washington, Maryland, that his glu-
cose was reaching dangerous levels
several times a day. “It was alarm-
ing at fi rst,” he said of the alerts the
device would send to his phone.
Over months, the readings helped
him change his diet and exercise
routine to avert those spikes and
bring the disease under control.
These days, that means taking a
brisk walk after a meal or having a
vegetable with dinner.
“It’s made a big difference in my
health,” said Hall.
This market ‘is going to
explode’
Makers of the devices increas-
ingly promote them as a way to mo-
tivate healthier eating and exercise.
The manufacturers spend mil-
lions of dollars pushing doctors to
prescribe continuous glucose moni-
tors, and they’re advertising directly
to patients on the internet and in
TV ads, including a spot starring
singer Nick Jonas during this year’s
Super Bowl.
Kevin Sayer, CEO of Dexcom, one
of the leading makers of the moni-
tors, told analysts last year that the
noninsulin Type 2 market is the
future. “I’m frequently told by our
team that, when this market goes,
it is going to explode. It’s not going
to be small, and it’s not going to be
slow,” he said.
“I believe, personally, at the
right price with the right solution,
patients will use it all the time,” he
added.
KHN (Kaiser Health News) is a
national newsroom that produces
in-depth journalism about health
issues. Together with Policy Analysis
and Polling, KHN is one of the three
major operating programs at KFF
(Kaiser Family Foundation). KFF is
an endowed nonprofi t organization
providing information on health issues
to the nation.
Amazon offers
telemedicine
By Matthew Barakat
Associated Press
mortality leveling off in
urban areas and appearing
Stroke death rates have
to increase slightly in rural
increased among middle-aged counties. “After a period of
adults in rural counties in
improvement, there’s been a
the U.S., according to new
stagnant trend in cerebrovas-
research that also found de-
cular mortality that African
clining deaths in urban areas Americans experience,” said
have recently stalled.
Cierny, a vascular neurology
Overall, stroke deaths
fellow at the Cleveland Clinic.
dropped nationally for more
Stroke mortality remains
than four decades before
high among Black people, the
progress started slowing in
study showed.
recent years. Researchers
The new research, present-
wanting to take a closer look ed this week at the American
zeroed in on what’s happen-
Stroke Association’s virtual
ing in rural versus urban
International Stroke Con-
areas.
ference, didn’t look at what
Using a national database might be causing the trou-
of people ages 35-64, re-
bling trend in rural areas.
searchers found stroke deaths
“Previous research found
rose nearly 2% per year in
higher in-hospital mortality
rural counties between 2013 in rural counties, but we also
and 2018. Urban counties
see disparities in classic car-
showed little or no change in diovascular risk factors, edu-
stroke deaths between 2013
cation, income, poverty and
and 2018, after dropping
other socioeconomic factors
between 1999 and 2012.
associated with poor health
“It’s disturbing to see that outcomes,” Cierny said. The
cerebrovascular health is not fi ndings are considered pre-
getting better in rural areas,” liminary until published in a
said the study’s lead research- peer-reviewed journal.
er, Dr. Marek Cierny.
About 60 million Ameri-
The study found similar
cans – 20% of the U.S. popula-
trends for Black people,
tion – live in rural areas.
with decreases in stroke
Rural residents live three
By Thor Christensen
American Heart Association News
years less than people in
urban areas, and rural areas
have higher death rates from
stroke and heart disease,
according to a rural health
advisory issued last year by the
AHA in its journal Circulation.
That report said rural
residents face higher rates of
tobacco use, physical inactivity,
obesity and diabetes, and are
more likely to be uninsured
and have fewer affordable
health insurance options than
in urban areas.
Cierny said the fi ndings
present “a big opportunity for
physicians and public health
departments to broaden their
access to cover more rural
areas. Telemedicine helps
achieve better geographical
coverage, but for long-term suc-
cess, we need to focus more on
upstream factors on building
healthy habits.”
Those habits, he said, are
what’s known as “Life’s Simple
7” and include getting regu-
lar physical activity, having
a healthy diet, not smoking
and managing blood pressure,
cholesterol, blood glucose and
weight.
See Strokes/Page 3B
FAMILY
OWNED
FALLS CHURCH, Va. — Amazon is making its
fi rst foray into providing health care services, an-
nouncing Wednesday that it will be offering its
Amazon Care telemedicine program to employers
nationwide.
Currently available to the company’s employees in
Washington state, Amazon Care is an app that con-
nects users virtually with doctors, nurse practitioners
and nurses who can provide services and treatment
over the phone 24 hours a day.
See Telemedicine/Page 3B
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