New de­vices of in­ter­est to di­a­bet­ics mon­i­tor blood glu­cose con­tin­u­ously.

Arkansas Democrat-Gazette - - STYLE - ROSE­MARY BOGGS Email me at: [email protected]­line.com

A while back a reader sent an email about us­ing a con­tin­u­ous glu­cose mon­i­tor. They are new to many peo­ple so I fig­ured it might be worth look­ing into.

On the web­site of Every­day Health (ev­ery­day­health.com), I read about a new de­vice ap­proved by the FDA in June. Here’s a short­cut link: arkansason­line.com/114glu­cose. An FDA news re­lease dis­cusses the de­vice, the Eversense Con­tin­u­ous Glu­cose Mon­i­tor­ing Sys­tem. There are sev­eral other brands on the mar­ket now.

I guess if we are go­ing to use some­thing that can mean life or death, FDA ap­proval might be in the plus col­umn.

If you are not fa­mil­iar with these de­vices, the Na­tional In­sti­tute of Di­a­betes and Di­ges­tive and Kid­ney Dis­eases (niddk.nih.gov) says that the de­vices au­to­mat­i­cally track blood glu­cose lev­els through­out the day and night. You can see your glu­cose lev­els any time at a glance, and can re­view the changes over a few hours or days, and see trends.

Such mon­i­tor­ing could help di­a­bet­ics make bet­ter de­ci­sions about food, phys­i­cal ac­tiv­ity and med­i­ca­tions.

I called the Univer­sity of Arkansas for Med­i­cal Sciences and was put in touch with Dr. Peter Goulden, the UAMS di­a­betes pro­gram di­rec­tor. He says that the con­tin­u­ous mon­i­tor is “ar­guably one of the big­gest steps to­ward di­a­betes care in the last few years. It frees the pa­tient from the chal­lenge of reg­u­lar fre­quent fin­ger­stick glu­cose test­ing.”

The gad­get con­sists of three parts — a wire­less mon­i­tor, a trans­mit­ter and a sen­sor that is in­serted un­der the skin of the arm or belly. It’s about half an inch long. There are sev­eral lay­ers to the sen­sor that are able to pro­vide mea­sure­ments ev­ery few min­utes of the glu­cose in the fluid sur­round­ing the sen­sor. The mea­sure­ments are con­verted into elec­tri­cal sig­nals and trans­mit­ted to a re­ceiv­ing de­vice or mon­i­tor.

The mon­i­tor can be part of an in­sulin pump or a sep­a­rate de­vice small enough for a pocket or purse. Some mon­i­tors send in­for­ma­tion di­rectly to a smart­phone or tablet. And some have fea­tures that in­clude:

■ An alarm that sounds when lev­els get too high or too low.

■ The abil­ity to note meals, phys­i­cal ac­tiv­ity and medicines on the de­vice.

■ The abil­ity to down­load data to a com­puter or smart de­vice more eas­ily to see glu­cose trends.

Some models will send the in­for­ma­tion right away, maybe to a par­ent, part­ner or care­giver. For ex­am­ple, if a child’s glu­cose level drops dan­ger­ously low overnight, the mon­i­tor could be set to wake the par­ent in the next room.

Re­searchers are work­ing to make mon­i­tors more ac­cu­rate and eas­ier to use, but sev­eral sources said that a fin­ger-stick glu­cose test twice a day to check the ac­cu­racy of the de­vice would be needed.

Goulden says that the mon­i­tors work well for Types 1 and 2 di­a­bet­ics.

In the last cou­ple of years, the in­sulin pump de­vices that in­te­grate with con­tin­u­ous mon­i­tor­ing de­vices have been made so they can vary the dose of in­sulin given minute by minute, ac­cord­ing to the mea­sured glu­cose level. This is es­sen­tially what the pan­creas does.

The in­sti­tute states that con­tin­u­ous glu­cose mon­i­tor­ing is one part of “ar­ti­fi­cial pan­creas” sys­tems that are now in use.

In 2016, the FDA ap­proved a type of ar­ti­fi­cial pan­creas sys­tem called a “hy­brid closed-loop sys­tem.” It tests blood-sugar lev­els ev­ery five min­utes day and night — us­ing con­tin­u­ous glu­cose mon­i­tor­ing tech­nol­ogy — and pro­vides the right amount of basal in­sulin, which is a long-act­ing in­sulin, in­jected through a sep­a­rate pump.

Along with the ver­sion that al­lows us to read it our­selves, there is a di­ag­nos­tic ver­sion. This is im­planted in the body at a doc­tor’s of­fice. The pa­tient goes back after sev­eral days to have the mon­i­tor re­moved and the in­for­ma­tion re­viewed by the doc­tor.

As with many ma­chines, the mon­i­tor will need to be cal­i­brated from time to time for ac­cu­racy.

Ac­cord­ing to Goulden, a pre­scrip­tion is needed for the de­vice, which will gen­er­ally in­clude a re­ceiver and trans­mit­ter. In ad­di­tion, a sen­sor will be pre­scribed. It will be re­placed ev­ery 10 to 14 days, de­pend­ing on the type of de­vice.

He says it is im­por­tant to un­der­stand what in­sur­ance will cover, be­cause many poli­cies won’t cover the ex­pense un­less the pa­tient re­quires four in­jec­tions of in­sulin a day.

So for those who don’t need in­sulin in­jec­tions or don’t need that much, and who have high de­ductibles and a lot of out-of-pocket ex­penses, a con­tin­u­ous glu­cose mon­i­tor would not be a vi­able choice, Goulden says.

Senseon­ics

The Eversense Con­tin­u­ous Glu­cose Mon­i­tor­ing Sys­tem in­cludes an im­plant that goes be­neath the skin (in­set) and (at right) a trans­mit­ter ap­plied over the skin dur­ing mon­i­tor­ing and a phone app.

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