‘Painless’ Glucose Monitors Pushed Despite Little Evidence They Help Most Diabetes Patients

‘Painless’ Glucose Monitors Pushed Despite Little Evidence They Help Most Diabetes Patients

 

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 the instant feedback provides a way to motivate healthier eating and exercise. But experts point out that the few studies on the monitors show conflicting results. (LYNNE SHALLCROSS / KHN)

This story also ran on NBC News.


A continuous glucose monitor holds a tiny sensor that’s inserted just under the skin, alleviating the need for patients to prick their fingers 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 diabetes wear the monitors today, twice the number in 2019, according to the investment firm 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 fingerstick 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 finger sticks, which cost less than a $1 a day, he said. But “the price point for these devices is not justifiable 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.

Lower Prices Help Propel Use

People with Type I diabetes — who make no insulin — need the frequent data from the monitors in order to inject the proper dose of a synthetic version of the hormone, via a pump or syringe. Because insulin injections can cause life-threatening drops in their blood sugar, the devices also provide a warning to patients when this is happening, particularly helpful while sleeping.

People with Type 2 diabetes, a different disease, do make insulin to control the upswings after eating, but their bodies don’t respond as vigorously as people without the disease. About 20% of Type 2 patients still inject insulin because their bodies don’t make enough and oral medications can’t control their diabetes.

Doctors often recommend that diabetes patients test their glucose at home to track whether they are reaching treatment goals and learn how medications, diet, exercise and stress affect blood sugar levels.

The crucial blood test doctors use, however, to monitor diabetes for people with Type 2 disease is called hemoglobin A1c, which measures average blood glucose levels over long periods of time. Neither finger-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 monitors also don’t assess blood glucose. Instead they measure the interstitial glucose level, which is the sugar level found in the fluid between the cells.

Companies seem determined to sell the monitors to people with Type 2 diabetes — those who inject insulin and those who don’t — because it’s a market of more than 30 million people. In contrast, about 1.6 million people have Type 1 diabetes.

Helping to fuel the uptake in demand for the monitors has been a drop in prices. The Abbott FreeStyle Libre, one of the leading and lowest-priced brands, costs $70 for the device and about $75 a month for sensors, which must be replaced every two weeks.

Another factor has been the expansion in insurance coverage.

Nearly all insurers cover continuous glucose monitors for people with Type 1 diabetes, for whom it’s a proven lifesaver. Today, nearly half of people with Type 1 diabetes use a monitor, according to Baird.

A small but growing number of insurers are beginning to cover the device for some Type 2 patients who don’t use insulin, including UnitedHealthcare and Maryland-based CareFirst BlueCross BlueShield. These insurers say they have seen initial success among members using the monitors along with health coaches to help keep their diabetes under control.

The few studies — mostly small and paid for by device-makers — examining the impact of the monitors on patient’s health show conflicting 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 fingers — 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 current evidence we have,” said Dr. Katrina 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 landmark 2017 study in JAMA Internal Medicine that showed no benefit to lowering hemoglobin A1c after one year regularly checking glucose levels through finger-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 certified 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 medications that can affect their blood sugar levels, she said, or for people who don’t have the dexterity to do finger-stick tests.

Yet, some patients like Trevis Hall credit the monitors for helping them get their disease under control.

Last year, Hall’s health plan, UnitedHealthcare, gave him a monitor 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 glucose was reaching dangerous levels several times a day. “It was alarming at first,” 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 increasingly promote them as a way to motivate healthier eating and exercise.

The manufacturers spend millions of dollars pushing doctors to prescribe continuous glucose monitors, 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 monitors, 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 nonprofit organization providing information on health issues to the nation.

Faith leaders push back against proposed ‘Souls to the Polls’ voting restrictions

Faith leaders push back against proposed ‘Souls to the Polls’ voting restrictions

Video Courtesy of The Choice


To the Rev. Fer’Rell Malone of Waycross, Georgia, the actions by his state legislators that could curtail Sunday “Souls to the Polls” activities are akin to a form of apartheid.

“They are literally evil, and they’re coming from men and women who say that they are Christians,” the Black pastor told reporters Wednesday (March 10) in a virtual news conference.

He said the lawmakers are focused on reducing effective strategies Black churches have historically employed to mobilize voters.

“They’re trying, with the voter suppression laws, to create a system of apartheid where they who have the power will retain the power,” he said.

RELATED: Biden victory in hand, Black church get-out-the-vote workers assess the future

Malone’s is one of more than 500 signatures on a Faith in Public Life petition delivered to Governor Brian Kemp that condemns proposed changes in voting policies they say will particularly harm people of color.

The Georgia House bill, which passed the Republican-majority body by a vote of 97-72 on Monday, would permit at least one Saturday for voting near the time of a future Election Day but would allow registrars to choose whether to offer voters an additional Saturday or Sunday to vote.

In recent elections in the state, Black church leaders have spearheaded “Souls to the Polls” campaigns that led worshippers directly from their pews to their polling places.

The nonpartisan Brennan Center for Justice reported this month that Georgia’s Black voters accounted for 36.5% percent of Sunday voters but only 26.8% of people who voted early on other days of the week.

Former Georgia House Minority Leader Stacey Abrams said this week there are more than 250 bills related to voting restrictions being considered by state legislators across the country.

Georgia’s House and Senate proposals, which Abrams said would particularly harm people of color, relate not only to Sunday voting but also would eliminate automatic voter registration and no-excuses absentee balloting and would require a copy of a driver’s license with mailed-in ballots.

“Black people, people of color have always been the target of voter suppression because it is when we lift our voices, it is when we participate in elections, it is when we have the right to full citizenship that the trajectory of this nation changes,” Abrams, who has a United Methodist background, said Tuesday on a Facebook Live program hosted by the African Methodist Episcopal Church’s newspaper, The Christian Recorder.

In January, the Rev. Raphael Warnock and Jon Ossoff, her state’s first Black and Jewish senators, respectively, were sworn in, giving the U.S. Senate a Democratic majority. Two months before on Election Day, a record Black voter turnout helped flip the Peach State from red to blue for the first time since 1992.

The Georgia state legislators are also proposing limitations that would criminalize volunteers — who are often connected to faith groups — if they provide food and drink to voters waiting in line outside polling places.

“The lines were so incredibly long that we had multiple reports of people fainting in lines for having to stand up for too long,” said Fair Fight Action organizing director Hillary Holley of the 2020 election, speaking during the news conference. “We saw ambulances have to get called because our elders were passing out while trying to vote.”

The Rev. Cassandra Gould, an AME minister who is the executive director of Missouri Faith Voices, said in an interview that her group has been fighting laws restricting voting, including as a co-plaintiff in a suit against the secretary of state that was dismissed on Tuesday.

Though Missouri doesn’t have early voting as Georgia does, Gould said her organization continues to oppose other kinds of voting restrictions that she says disproportionately affect African Americans. In February, the Missouri House passed a bill that requires voters to provide a photo ID or cast a provisional ballot.

“For me it’s really egregious when there are concentrated efforts to minimize democracy, to actually shrink the electorate,” said Gould, who is also the religious affairs director for the state’s NAACP chapter.

The developments in Georgia came during the anniversary week of Bloody Sunday, when church leaders and other civil rights activists were attacked by state troopers as they fought and bled for voting rights in Alabama in 1965.

Min. Shavonne Williams, an Augusta-based organizing ambassador for Faith in Public Life, recalled that historic time and said voting has long been a unified front for Black church members.

But, in addition to concerns about Black voters, the legislators’ actions have prompted questions about constitutionality and religious freedom, according to Graham Younger, Georgia director for Faith in Public Life.

Early weekend voting opportunities are vital to many residents who are unable for various reasons to vote on a weekday. Limiting which weekend day polls may be open, however, can affect worshippers of a variety of faiths and racial/ethnic groups, including Jewish congregants and members of Seventh-day Adventist churches who cannot vote on Saturdays, due to Sabbath restrictions.

“The choice that counties will now be making is between different groups’ holy days,” Younger said. “Not everyone’s holy day is Sunday.”

Conservative religious groups, including Family Research Council, support “ election integrity ” state-level provisions such as ones that require voter identification and limit no-excuses mail-in voting.

Pastor Mike McBride, a Pentecostal minister based in California who was involved in 2020 Black church voter mobilization initiatives, said organizers are pushing back against legislators seeking to reduce “Souls to the Polls” and other activities.

As they work on signing letters and raising awareness about state proposals, they also will urge passage of the For the People Act, which he hopes will “take the teeth out of a lot of these very wicked Republican schemes.”

“I believe this is tantamount to the church bombings the Ku Klux Klan did to terrorize Black people from engaging in voter registration and engagement,” said McBride, a founder of the Black Church Action Fund, in an interview. “Rather than using church bombs, they’re trying to use these kinds of state policies.”