Dr William Polonsky on the Promising Potential of Continuous Glucose Monitoring
Continuous glucose monitoring (CGM) has the potential to revolutionize diabetes care for patients with type 2 diabetes, whether they are on insulin therapy or not, but the technology must be accompanied by stronger support from clinicians in order to be most successful, explained William Polonsky, PhD, CDE, president of the Behavioral Diabetes Institute and associate clinical professor at University of California, San Diego.
Transcript (slightly modified) What are the arguments for and against CGM for people with T2D on insulin therapy?
For people with type 2 diabetes who are taking insulin, there’s a lot of pros and cons about whether continuous glucose monitoring is useful or not useful. In truth, I think there’s no doubt over the next few years it’s going to be proven without any doubt that it’s, in fact, extremely useful and should be the standard of care for most patients.
In the current climate where we are right now, there are still some significant negatives; negatives in that for many people, the way we tend to offer CGM might not be sufficient for type 2, because a lot of this has to do with, are people engaged enough in their diabetes? Are they numerate enough, are they comfortable enough with numbers and with understanding their diabetes? If they can really make use of all of that continuous data, it could really help them be successful.
So, that’s my concern. I think what we’re going to see in the future and what’s necessary is probably a lot more support; whether that means live support or digital support for people to make sense of data, to figure out the actions they can take to make a difference, to help people be enthused about this enough that can make a difference.
I see the promise of CGM as huge and golden for people with type 2 as we move forward, both if they’re taking insulin or not taking insulin, but we see the constraint really about whether people, everybody in the majority, can really make use of it truly effectively. Of course, there’s other issues, of whether cost is a significant issue.
While the systems are obviously so much more accurate and powerful now, there’s still some bulkiness, stuff you’ve got to carry, associated with these devices. We know though, in the next few years, that’s going to be smaller, more efficient, less expensive, and that again is going to lead to what I think is without a doubt a real transformation in how this is going to become the standard of care for folks.
What are the pros and cons of CGM for people with T2D not taking insulin?
In terms of the use of continuous glucose monitoring for type 2 patients who are not on insulin, I think there are some other issues that people think about and talk about a lot. Nowadays, there is a lot of controversy whether even standard blood glucose monitoring is of any value for type 2 patients not on insulin. We know that’s led to a lot of insurance companies and countries actually cutting back on reimbursement for even blood glucose monitoring strips.
Again, the major issue is because what we see is not that blood glucose monitoring isn’t useful, it’s just not useful the way we’ve been doing it. If you’re providing people with information about blood glucose values in their life, and you’ve never helped them understand what on earth to do with this information, and their physicians aren’t really helping with that, it’s not a big surprise this really does become a fairly un-useful and in fact often demotivating task.
CGM won’t cure that. What cures that is when we help equip healthcare providers, equip patients with the support and help and skills they need to really make use of this information that can make a difference. Again, I think the promise long-term, even in the medium term, is huge, but we have a lot of biases towards the use of glucose monitoring in type 2 who’s not on insulin that we have to overcome.