I guess before I start this series of posts on ATTD 2018 I should introduce myself.
My real name is Chris Aldred and I’m from the UK.
I was diagnosed with Type 1 Diabetes in 1994 at the age of 25.
I blog and tweet about my life with Diabetes under the guise of The Grumpy Pumper.
I have seen many changes in Diabetes technology over my 23 years of living with the condition, from twice daily injections and a blood glucose (BG) meter that was steam powered and took an age to give you a reading, to now using an insulin pump, Continuous Glucose Monitor (CGM) alongside my battery powered, 5 second to result BG meter. So I’m always interested in hearing about advances in this field.
In the past I’ve always avoided industry symposia.
Well, I assumed the it would be combination of the industry telling me that their new product will make my life with Diabetes so much better or that they have a new intrusive way of sticking a hole in my finger to draw blood. A quick tip here. If it’s going to draw blood then its intrusive……
I also assumed that there will be a panel of health care professionals (HCP) telling me that I’m not using my kit right and that if I did, guess what?, my life would be better.
So today I broke that rule and attended the Ascensia symposium entitled “BGM and CGM, is there only one Future?”
The first speaker was Adam Brown. I’ve known this guy for a few years now. He also lives with Type 1 and I have to say it’s a refreshing change to see industry realise that they need to get the people with Diabetes (PWDs) that use their products to talk to them and to the HCPs that prescribe the products. Living with Diabetes can vastly vary from the text book.
Adam talked about the use of BG meters and number of blood checks that are done on average by each PWD. The numbers were surprisingly low and he highlighted that most PWDs have very few data readings per day to make informed dosing decisions if they just use a BG meter. He then moved onto CGM. CGM (including Flash Glucose Monitoring) is only used by 1-3% of PWDs worldwide. So whilst it gives much more data, and in real time in some cases, it is not accessible for the vast majority of PWDs.
You’d think that of that 1-3%, most would only use their BG meter to calibrate the CGM or for the legal requirements around driving, but no, something like 45% of these PWDs still use a BG meter more than 6 times a day. Personally I can back this up. I do less BG checks when using CGM, but I easily do 6 a day.
I think for me it’s because I trust my BG meter. At diagnosis it was one of the things I was given to help me. It’s been one of the only dependable things in my Diabetes tool kit. CGM gets more inaccurate over time through use (yes I use it longer than warranty) and it drifts at times in accuracy. My meter just keeps going. Its results are my reference point.
Discussion moved to meters that Bluetooth to smart phone apps. Statistics show that use of these meters is again low.
The next speaker, Dr Guido Freckmann, talked about the difference between BGM and CGM
Unsurprisingly BGM is just that. It checks your BG level from a drop of blood.
CGM? Well that’s a bit more complicated. It’s an estimation of the BG level based on a reading from interstitial fluid and a lot of complicated maths in an algorithm to work out that figure. Also, there is a time lag. Unlike BGM, which gives me my BG reading at that point in time, the CGM estimation is from effectively 6 minutes ago. However that lag depends on certain things and can vary from person to person (4-20 min). I can tell you from experience that it can vary on the same person. My CGM lag can be different each day at times. So you can probably see that whist I love my CGM, I will always trust my BG meter and will always depend on it whether I am wearing CGM or not.
Then it all got a bit mathematical with Dr Marc Breton looking at the numbers behind MARD. The stand out point for me was that I can have the most accurate meter in the world, but if I don’t change my lancet for every BG check (I don’t), If I don’t wash my hands properly (I don’t, as it is not always practical) or if my strips have not been stored correctly (I think I’m ok on that one) then my results may not be as accurate as they should be. It’s a balance of real life, convenience and the way things “should really be done”.
The final speaker was Dr Steven Russell talking about the importance of accuracy with the closed loop systems (Artificial Pancreas). He pointed out that any PWD whose BG is within range is never far away from dropping into a hypo (hypoglycaemia) and that any automated insulin delivery system needs accurate BG data to ensure that the right amounts of insulin are infused to walk this fine line. So this could need someone like me to change my behaviours, to ensure that I’m getting accurate BG results and avoid the risk of making an accurate CGM sensor into a less accurate one through calibration.
The session wrapped up with a lively Q&A session led by chair, Professor Lutz Heinemann.
My personal view on BGM and CGM, is there only one future?
At least not for a very long time. For me and my Diabetes management they complement each other with my BG meter being my safety net.