“Results: Mean HbA1c levels decreased to 7.7% in the CGM group [vs 8.0% for the control group] at 24 weeks.”
The gain is modest (0.3% after 6 months compared to the control group) but statistically significant. Given our experience with CGMs, I feel that, while the average improvement is slight, it is quite possible that motivated or hard-working users see a much greater improvement, and that the small improvement captured by the study mostly captures the lack of commitment or of training for the majority of the patients.
I think the way Type 2’s are educated is just totally different. My dad has Type 2 and he still has such a rudimentary understanding of what affects his BG. He’s technically well-controlled, having never really gone much out of the 6.something range. And yet he checks his BG twice a day, never after meals, and doesn’t even seem to grasp that carbs, not just sugar, raise BG. He was taught how to manage his diabetes nearly 20 years ago, and his knowledge and treatment plan has barely changed since then.
So I’m trying to imagine him using the data from a CGM proactively and coming up blank. It’s likely a little different for those who use insulin but I’m sure the overall level of knowledge, the expectation of effort put in, etc., is just a whole different universe.
This doesn’t surprise me at all. If you get a chance to look at the individual data my guess is you would see a few participants that really took on the challenge (i.e 10-20%) and crushed it with the CGM data. There would be a second group that gained some insight and changed the way they did things and got a small change. Then there would be a big third group that either didn’t wear the sensor, or didn’t understand/adjust the way they were doing things and had no change in A1c.
In my experience even a modest change like this in a group, probably meant a good group of people improved a bunch. The medical community just has to identify who this group is.
Yeah - that would be far more meaningful than an overall average for the group. I tend to hate averages. How often do averages convey actual useful (and actionable) information as opposed to obscuring the finer details that contain truly good data.
Agreed. And since Dexcom paid for this study, you can see the signs of an immature clinical team. If Medtronic had sponsored the study, the study design and paper write-up would have also included much more information about the people that really responded so they could use that for Marketing. i.e. in our study 10% of the population saw a 30% drop in A1c using our CGM. Which plays much better in the marketplace and would not of cost them any additional dollars to deliver.
That’s the issue with T2, so many do not get the education to know that there is so much more to be done. The nature of T2 makes one believe it is no big deal, it is not an immediate threat in the beginning and way to many are not educated about the true nature of the threat. So many hear from their doctor to go home, take these pills and try to eat less when they really need to hear in graphic detail what the future holds for them if they do not take this disease seriously, they need to hear it strongly and often.
Similar to my Mom who has Type 2 for past 30 years. I bring her extra BG strips, and suggest to test after meals, but she says she always forgets. Her doctor only wants to see logs for once a day fasting. Her A1Cs were in mid-6s until the last few years and now in the 7’s with less activity. She is normal to underweight. I don’t think she would change anything even with a CGMS which I’m pretty sure she would not agree to.
That to me is really sad. I must say that we were blessed to have our son diagnosed at a children’s hospital, the education was amazing, it involved 12 contact hours 1:1 with a diabetes educator who was also a parent of a T1, followed by 6 1-2 hour classes over the next 6 months. I have met T1’s that were diagnosed as adults and they weren’t offered this educational opportunity which I find sad as well. It really gave us the foundational knowledge to begin advanced learning.
Even though every T2’s wouldn’t take advantage of the opportunity, it would be so much better for some of them. And so inexpensive in the overall cost of lifetime treatment of their disease.
It’s interesting, because my dad was diagnosed with T2 concomitant to getting triple bypass surgery, and he actually had several nutritionists come to talk to him in the hospital, with total educational hours probably adding up to 6 or 10. So in terms of time and resources they were certainly pretty thorough on diagnosis. They even had some education for us as the family members and little quizzes where they asked him to estimate portion size from pictures, etc… But the content of the education was just so simplistic and basic…possibly at that time the level of understanding was a lot lower, but even so, kind of shocking. It was basically about avoiding sweets, portion control and eating fruits and veggies and whole grains, and avoiding saturated fat – basically the same advice you could give to ANY person in this country as part of the generic “healthy diet” spiel.
Where my dad’s education really dropped off, I think, is in the many years after his initial diagnosis. He was given the same meds year after year, the same monitoring advice, and then nobody bothered to update his knowledge base. They just figured his A1C was good enough. Sadly, a 6.5 is low enough to prevent severe complications, but not the more subtle ones like cognitive decline, and not the overall accelerated aging that comes from excess glucose exposure.
I guess the fair comparison is how much education do T1s get long after diagnosis – for instance, I’m sure there are plenty still on “exchange” diets and “sliding scales” because they achieved okay-ish results with that and the doctor never bothered to follow-up. What we’re doing is pretty cutting edge/innovative now, but maybe in 5 years it will be outdated – will our Peds Endo make sure we are being brought up to speed? That kind of thing.
My D education on diagnosis consisted of a vial of Lente, a vial of Regular, a prescription for both, a bag of syringes, and a bottle of pee strips. No demonstrations, just a generic starting dose recommendation.
Not at all what one might consider proper education, but it worked.
@Chris I did what research I could and figured activity curves for both insulins. Then planned to eat at their peaks. Took a little while to figure out correct dosages though. Trial and error, with emphasis on error.
“Eating to the insulin” certainly is bass ackwards though.