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Dr. Bill's Commentaries

Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.

CGM Continues to Improve   (October 8, 2012)

One of the two US makers of continuous glucose monitors (CGM) announced today that they have improved their CGM device by approximately 19 percent in overall accuracy compared to their earlier model, with up to 30% improvement in accuracy in the hypoglycemia range (when the blood glucose is less than 70mg/dl). The company, Dexcom, describes their new CGM (which they call the “Dexcom G4 Platinum”) as setting “a new standard for commercially available CGMs.” The device also has a transmission range (the distance between the sensor-transmitter device and the receiver device) that’s now 20 foot – which they point out is three times further than the alternative brand (presumably they mean Medtronic, maker of a CGM combined with a pump as well as a stand-alone CGM system). (See their press release, U.S. FDA Approves the Dexcom G4™ PLATINUM Continuous Glucose Monitor.)

Their receivers now come in a choice of colors: "Classic Black, Tickled Pink and Ocean Blue" (whoopee! I’ll still take basic black), and has a color LCD display screen. Dexcom’s website has more information, but I can’t see links to the studies that support their claims. But on the other hand, the G4 manual is on-line already – from the UK portion of their website!

This new-and-definitely improved gadget will be a great help for me, as I keep my glucose levels in near-hypo levels most of the time, and the Seven-Plus CGM I’ve been using occasionally fools me completely on what my BG level is. I’m looking forward to upgrading as soon as possible.

Speaking with company representatives today, I learned that the device itself, and the sensors for it, will be shipping in late October. For people who purchased their Seven Plus recently, there will be an upgrade price ($399) for getting the new G4 device.

But the company will not take back the sensors – and I just purchased 6 boxes of 4 each for my Seven Plus (which would last 24 weeks if I used them for a week as recommended, but actually 48 weeks’ worth as I use them for two weeks per sensor). I paid cash for them, as I’m on Medicare, and Medicare refuses to pay for CGM under any circumstances. So I’m not sure what to do with them – the list price is like a MSRP on a car, namely inflated. You’ll see Durable Medical Equipment suppliers quote prices like a “Catalog Price of $647.65” (at Edgepark Medical Supplies), but at one diabetes forum, it’s stated that “Dexcom was selling a pack of 4 sensors for $280, if you agree to buy a total of 6 packs or more over the course of a year.” That’s close to what I paid: $1734 for 6 boxes is $289 per box of four. That money is unreclaimable: even if someone wanted to buy my sensors, I don’t think I could ethically do so, as they are now inferior to a better device. Sort of like trying to sell software for an Apple II or Commodore 64 computer -- there are better products out there nowadays so the older ones are now history.

My dream is that with the new-and-improved CGM models, and with the competition between the two major CGM manufacturers, the prices will come down so most people with diabetes can afford to use them. There’s data that says that CGM is indeed effective in improving BG control in people with T2DM; but of course, some insurance companies (and Medicare) won’t reimburse for CGM yet, so it can be awfully expensive to do the CGM thing unless you have excellent insurance.

Actually, I’m hope for a day – preferably sooner rather than later – when CGM replaces BG testing, as once upon a time, BG testing replaced urine sugar testing. I can hope, can't I?

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