SMBG for non-insulin-dependent T2s?

No solid conclusion is offered but an interesting discussion nonetheless:

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Interesting discussion. And makes sense to me. If you only take one or two readings a day, how much information are you going to get that will help you make decisions? Not much.

An interesting study would be to take a few of the non-insulin type 2’s and give them a CGM and see if they change any behaviors.

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I feel like a better treatment for T2Ds would be to give them CGMs for two weeks, twice a year, where they test out their most common patterns.
That certainly would provide more revealing information than the once-daily finger prick my dad does in the morning. He has no idea how much certain foods spike his BG.

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Dexcom CEO:

The DexCom and Verily R&D teams are also beginning to accelerate effort on the smaller, less expensive second-generation system. Our early experience continues to show the value of real-time connected CGM outside of the insulin intensive diabetes population. Real-time data is intuitive and allows patients and caregivers to quickly optimize drug therapies and behavior.

We have electronics configurations on the horizon that will come very quickly that are orders of magnitude cheaper than the ones that we make now.
We’ve had cost reduction plans in place for a long time. And as you look out three, four years, then we have our Verily disposable products coming, which really have aggressive cost targets, and we hit them, we can compete that way as well.

Certainly, our Verily products are designed to last 14 days and the electronics isn’t going to work anymore after that. The battery will be dead.

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Speaking as one of the few T2’s in the room I think not requesting that a patient self monitor would be a mistake. Self monitoring if its actually done has benefits, it helps someone see the effect that diet has, it can help slow the progression of T2, it can reduce dependence on medications. To not at least suggest self monitoring would reinforce an attitude that a large number of T2’s have. An attitude that T2 is no big deal. Its a damaging attitude that only harms a T2 later on.

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Agreed. But it is a step higher to have a study that proves (shows - whatever) this. Dexcom has just completed a study that shows improvement for T2 who are on insulin. Dexcom does seem quite savvy so I fully expect as they complete their device designed for non-intensive T2 (ie - no insulin) that they will have a study performed which would likely show what seems intuitively obvious.

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@SLEE, I agree that recommending patients not monitor is a mistake. Not having the experience, if you were in charge, how many sticks would a non-insulin using type 2 need to get beneficial information?

My thinking would be before and after each meal, but that is only a semi-educated guess.

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Let’s really brainstorm on this and I will compile suggestions into a letter to that publication.

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Dexcom is looking to entirely transform the landscape of the non-intensive T2 population over the next 3~5 years as it relates to monitoring.

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It does seem like you’d have to have a decent amount of testing to get useful data, such as before/after each meal—I would hypothesize that intensive monitoring for brief periods (whether via CGM or a lot of fingersticks) that inform diet choices followed by somewhat regular testing spurts to ensure that the changes are working might be better than testing 1-3x day every day continuously. Someone might be able to lay off testing somewhat between spurts, if their condition seems relatively stable and they aren’t using countermeasures to correct blood sugars. It would be interesting to compare those methods (intensive spurts vs lower levels regular testing) in an RCT, since I would suspect relatively few T2s who don’t use insulin test frequently (before/after all meals) all the time. (I don’t even think that many people on insulin do, outside of the forum bubble.)

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Thanks for pointing this out. I have often wondered why there is such a strong divide between the way that T1 and T2 are approached. I mean, obviously, there’s a vast difference in management strategies if you’re not insulin dependent. But I think that having T2 is also a risk over time, and I wish the doctors encouraged people to self-monitor more and explained diet and exercise more clearly to their patients, and discussed the seriousness of it. (although, maybe I shouldn’t be so fast to blame doctors, this is from personal experience not science.) I am always surprised when I’ve known someone for quite some time and then find out they have T2.

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It seems like the difference with T2D and intensive monitoring (vs T1) is in how much the patient can modulate therapy in response to the data. If someone is on insulin, particularly if on multi-dose, then they can probably use the data to make small changes in regimen that are beneficial. But if they are on orals, I’m not sure most patients feel empowered or have the knowledge to adjust their oral meds – in which case, if no behavior change is going to result from the monitoring until a visit to the MD 3 months later, more data may not make a difference in control. I guess one could make dietary adjustments, if they hadn’t already…

Would be curious to know from T2D folks if they feel the culture/diabetes education for T2 is less encouraging of self-adjusting medication doses etc.

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My brother is on oral meds and classified by his doctor as a type 2. I do not know whether he was tested for anti bodies. He definitely has no leverage to adjust his medication to counter any hyperglycemic episodes. He carries, candy/sugar to counter hypoglycemic episodes, which rarely occur because he does eat regularly. Oral meds are not “smart”, the sulfonylureas cannot tell the pancreas how much insulin to secrete. I suspect that BG’s will be overly high or overly low, with a net a1c of ‘acceptable’ around 7 or so. Healthcare professionals would deem this to be acceptable. Unfortunately, most of us would not consider this to be good diabetes management.

For Dexcom, it would be a terrific “public service” if they could provide low cost CGM to as many people as possible. I’d be curious as to what a healthy non diabetic’s trace would look like for 2 weeks.

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Can’t tell you what two weeks looks like, but this is what a trace looks like in a normal person. Based on this publication:
Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals
Guido Freckmann, M.D.,1 Sven Hagenlocher,1 Annette Baumstark, Ph.D.,1 Nina Jendrike, M.D.,1 Ralph C. Gillen, Ph.D.,1 Katja Rössner, M.Sc.,2 and Cornelia Haug, M.D.1

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I bet I could hit 160 easy with a bagel.

Good handful of Swedish Fish - probably 180.

Don’t some of you parents of T1s send kids to diabetes camps without CGMs? If so, you could wear it for a week or two…

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I’m not sure there is any number that is important. Just a daily fasting test can mean a lot to a non insulin dependent T2. It tells them in a basic way how well they are doing. The strategy for the non insulin dependent is to coax their own body into controlling their BG. Daily test should be the standard at least. Everyone needs a daily scorecard to see if what they are doing is working

A number in time does not amount to a lot unless the PWD is motivated. If a person is motivated I agree that the more testing the better.

A large percentage of non insulin dependent T2’s have a completely different attitude about their disease. They do not see it as an immediate threat but rather as something ominous in the future, they think they have time to save themselves. It is not like T1 where there are immediate consequences. Human nature is the biggest threat to a T2

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