(And Why Diabetes is Like Judaism…)

Today, Jews around the world are celebrating their traditional New Year’s holiday, known as Rosh Hashanah, which translates literally to “the head of the year.”  We eat apples and honey, to usher in the beginning of a sweet new year (no idea how to properly dose insulin for that, btw).  But it’s not only the beginning of a new calendar year; it’s considered a celebration of the Birthday of the World.

[I read that Rosh Hashanah is particularly auspicious this year, as the date coincides with the 70th anniversary of “that infamous moment on September 30, 1938, when Neville Chamberlain stepped off a plane, waving a sheet of paper like a white flag of surrender, and then declared outside 10 Downing Street peace for our time” — by standing up to those who sought to seize absolute power in World War II.]

This new year in Jewish history will be 5769.  That’s a long, long time.  And as history tells us, the Jewish people spent much of that time being ridiculed, exiled, and persecuted.  They had about as little reason to keep up a message of hope as any dogged prey.  But that’s just what they did.

Seemingly against all reason, they just kept talking about hope, about improving the world, about trying to do it better next time.  Rosh Hashanah was and remains “a time to look ahead with hope.”

Like the secular New Year, this holiday calls on people to transform their lives, by looking back at the year past and determining what they can do better. “It teaches us that we can stop repeating destructive patterns of behavior and move on.”  There’s always room for a fresh start and a new beginning, even when things look hopeless.

And it strikes me that this is kind of the way we ought to — or hopefully do — live our lives with diabetes: full of hope despite the odds, and ready to try a fresh start even after we’ve stumbled again and again.  Of course with diabetes, you’ve got to recommit to this transformation every single morning when you get out of bed (sigh).

There’s even a Rosh Hashanah tradition of casting off your “sins” (your worldly mistakes, not your moral shortcomings) by tossing away bread crumbs in a creek or park — as if to say, “be gone, boo-boos, let me start over today.”  Wouldn’t it be cathartic to go for a walk and ritually “cast off” all the diabetes mistakes you’ve made?  Let the birds eat them!

When I think about it, even the crux of Rosh Hashanah could be pure Diabetes Doctrine:  “Although the future is uncertain, and fraught with peril, let us look ahead with hope.”  May it be so.

In that spirit: Happy Birthday, World.

Getting a jump on Diabetes Awareness Month (coming in November), Novo Nordisk, Discovery Health and the JDRF today launched something called Young Voices Unite — a national online video campaign, inspired by the book published by Novo Nordisk a few years ago.

They’re inviting teens and young adults affected by Type 1 diabetes to submit a 1-minute video message with: 1) their personal story and 2) how our next president can help change the future of diabetes. Discovery Health will give the videos national exposure and for each video submission, Novo Nordisk will donate funds to JDRF (up to $25,000).

It’s weird how many contests are popping up for diabetes these days.  To think: years ago, who ever singled people out for being inspirational with a chronic illness? Today, we’ve got all kinds of honorary awards and creative competitions…

The top 10 videos selected in this program will be featured during the World Diabetes Day Young Voices: Life with Diabetes Forum in New York City. Submitting videos is free of charge and can be done at www.DiscoveryHealth.com.  The deadline is October 24th!

A brief word from the organizers:

“As you well know, among the life-changing experiences during the transition from adolescence to adulthood, teens and young adults who live with type 1 diabetes are confronted with unique crossroads such as, “Will my parents trust that I will be okay in college?”; “How do I tell my boyfriend or girlfriend?”; “How do I get my parents to trust that I can manage my disease?” We are hoping to hear from people currently going through these transitions as well as those who remember going through them.

We hope everyone affected by diabetes will take advantage of this opportunity to get their desires, attitudes, wishes and needs about diabetes heard!  Additional information is available HERE.”

Happy D-vlogging.

I had a bad food week last week.  So naturally I turned to the Internet.  Got to stop munching all that high-fat stuff!  Time to take a closer look at all that food/nutrition stuff in my Inbox.

Somehow I got on the email list of a group called the Nutrition and Metabolism Society, which is “dedicated to the incorporation of biochemical metabolism to problems of obesity, diabetes, and cardiovascular disease.” But it’s not as boring as it sounds.  There are some good tips and book recommendations on the sites, along with some fun, proud-to-be-geeky T-shirts.

One of the sites they recommend is Know What You Eat! from Nutritiondata.com.  It’s a great tool to instantly look up the nutrition specs on just about any food you might like.  “So much fun it can become addicting!” they say

Furthermore, the Wellsphere folks are inviting bloggers to feature this widget, which makes it easy to search this site, a big aggregation of “health knowledge made personal”:

Just for fun I punched in “carbs in banana” and got back about a dozen blog posts, eight videos, five high-quality photos, and numerous news and community links on the topic.  And yes, the carb count of your average banana: 23 grams (although that seems awfully low?)

And last but certainly not least, I wanted to share a great, pragmatic list of Basic Diabetic Food Tips from John Crowley of Alliance Health (developers of the buzzing DiabeticConnect community).  John has a son with Type 1 who is now 16 years old. He put this list together for a friend, and it “certainly isn’t a comprehensive list, but I think it’s a good start,” he writes.

1. Stop buying white bread and white rice. Plain and simple, if you don’t have
it in your house, you will eat a lot less of it. These white carbohydrates have
very little nutritional benefits and a whole lot of blood sugar spikes.

2. Check your plate for color before you start eating. If your plate is all one
color (usually brown or white), you need to make drastic changes. You should
have greens, yellows, reds, and oranges on your plate as often as possible.

3. Avoid toppings and condiments that you don’t need. Why does everyone put
butter on their bread? Why do we have to have cream cheese on a bagel? Why add
200 calories to a sandwich with a spread that you don’t need? Ask yourself if
you can simply leave it off. Choose low-calories/low-carb alternatives like
mustard and balsamic vinegar.

4. Fresh raw vegetables are your best friend. When you’re planning your meals,
start envisioning building your meal from crisp, fresh, dark-green lettuce or
cruciferous veggies (like broccoli, cabbage, and collared greens). Then add your
favorites: carrots, squash, cucumbers, peppers, onions, whatever.

5. Lean proteins are your next best friend. Chicken breast, turkey breast, and
fish. These proteins provide good sustained energy without spiking your blood
sugar. Beef and pork (and other red meats) will do the same but the lean meats
have much lower fat and cholesterol.

6. Use carbohydrates as a garnish. We have to change our thinking. The “bowl” of
mashed potatoes filled with gravy was the center-piece of the dinner plate for
our grand parents. We simply can’t rely on starchy vegetables or breads to be
the foundation of our diet any more.

7. If it comes in a sealed plastic wrapper, it most likely shouldn’t go in your
mouth. There’s a reason why we use the same word to describe garbage and highly
processed high-calorie packaged foods: JUNK.

8. When you do choose carbohydrates, choose healthy ones. Whole grain breads.
Brown and wild rice. Fresh fruits.

Feel free to add your “rules” to the list, too.

Late-breaking news: President Bush signed the Americans with Disabilities Act Amendments Act (ADA-AA) into law today.  The American Diabetes Association and a whole host of other patient and advocacy organizations are dancing in the streets! Or at least, shooting out celebratory press releases.

Why is this so big?

The Disabilities Act protects the civil rights of people who are treated unfairly because of their disability or medical condition.  But, as reported in some detail here at DiabetesMine earlier, the law had been all twisted out of whack over the last decades. A series of Supreme Court decisions severely narrowed who is covered, which in particular exempted many people with diabetes.

Interpretation of this law had become so warped that “people were too disabled for the job and not disabled enough for protection,” according to a spokeswoman from the Consortium for Citizens with Disabilities (CCD).

The new amendment — now law — will remedy this by:

• Prohibiting the consideration of measures that reduce or mitigate the impact of impairment—such as medication, prosthetics and assistive technology—in determining whether an individual has a disability.

• Covering workers whose employers discriminate against them based on a perception that the worker is impaired, regardless of whether the worker has a disability.

• Clarifying that the Americans with Disabilities Act provides broad coverage to protect anyone who faces discrimination on the basis of a disability.

Bush Junior was joined by his father for the signing ceremony. Very fitting, since the 1990 Americans With Disabilities Act was one of the major domestic policy achievements of the elder Bush.

The Associated Press reports, however, that “Bush (Junior) signed the bill without public comment or fanfare.”  Whatever.  This will still likely stand as one of the few good moves that history will recall in association with this particular Administration.

I’m not sure there’s any real resolution to this problem.  I just couldn’t help pointing out how astounded I am to discover how many people are out there living with diabetes who have so little idea what they’re up against.  What you don’t know CAN hurt you.

On the new community, I hear again and again from people who don’t know whether they have Type 1 or Type 2 diabetes.  Either their doctor isn’t sure, or said doctor hasn’t explained the difference to them (mostly general practitioners, I hope and assume).  I hear from parents whose children were recently diagnosed with Type 1, but who don’t know that it is an autoimmune disease, or even what that means.

I hear from people upset that their oral meds and dieting attempts just aren’t working — “my sugars are always 170 or over and I’m not feeling well” — but whose sole purpose in writing to me is to ask how they can “avoid going on shots” (?!)

I hear from people who say they just found out they have diabetes, but they feel fine other than “this strange tingling in my toes — can that somehow be related?”

Clearly, people aren’t getting enough education about diabetes and the damage it can cause, let alone the best ways to treat it.  And when I say “people,” I mean people with diabetes!

Here we are, approaching November, which is designated American National Diabetes Month, with the aim to raise awareness of this disease because “the public doesn’t seem to grasp the gravity of the situation.”  And I’m thinking “Hell, the patients aren’t grasping it either! Why don’t we start with them?”  But where do we start?  Doctors and healthcare professionals need to do a better job of informing patients.  Still, we can’t lay it ALL in their laps.

For those who are active online, there are SO MANY great resources.  But what about the multiples of patients out there who are less active online and less inclined to find this stuff?

The only thing that comes to mind right now is the idea of dropping leaflets or information packets from airplanes, like the Allies did over Germany in World War II.  You go out to get your morning paper, and find your Diabetes Info Packet on the driveway.  “Got Diabetes?  Open Immediately.”

Know someone who needs one of those?  At the very least, you can send them HERE or HERE.

Like Birdie, I love my husband very much.  I can honestly parrot her sentiments exactly, that mine is also “not only a terrific person whose company I never cease to enjoy, he’s also been an amazing partner to me when it comes to my life with diabetes.” Except for one tiny little thing: Isn’t it strange to recognize that the person closest to you in the entire world doesn’t really have a clue about what diabetes means to your day-to-day existence?  I mean, how could he?

When we say that diabetes is invisible, we don’t just mean that no one saw my glucose meter today.  We mean that the irritability, the moodiness, the throbbing headache and frustration when we’re high, and even the shakes and sweating when we’re low are not always obvious “diabetes markers” to others.  How can my partner know the difference between all that and I’m just irked at you right now?  I suppose I can’t expect him to.  There are no lights that start blinking to alert him that “I am now having a diabetic issue.”

Which maybe explains why it kind of upsets me sometimes when he praises me for my writing, or furthermore for staying strong and working to “turn the diabetes into a positive force in our lives.”  Because that’s only half of the picture.  The other half are the times when I’m in a tailspin, and maybe not treating him so nice, which I always regret.  But in that moment my jaw is either clenched in rage or my eyes are brimming with tears, and I can’t help myself.

Intimacy is a delicate enough proposition anyway, without mixing in a “condition” that can make it so easy to misread each other.

As Birdie notes, marriage inevitably calls for trade-offs and bargains and compromises. Inevitably there will be times of friction and misunderstanding.  For us, I realize that many of those times are when I feel most alone with the dark side of diabetes, railing against it without success.

Funny that another kindred spirit, Scott J, says his wife is a “fixer” — the type who always wants to DO something to FIX a diabetes problem he might be dealing with.  I always thought that being a “fixer” was an inherently male trait, a la “Men Are from Mars, Women Are from Venus.”  My husband’s a classic male fixer (head for the cave and come out with a solution).  And he’s exceptionally good at it.  He’s quite a brilliant strategist and team leader in the business world.  But as Scott notes: “diabetes just doesn’t work like that.” It can’t be hammered into a corner or charted out analytically on a white board.  I’m so very well aware of that.

And the truth is, being the Venus counterpart to his Mars caveman, most of the time I’m not really looking for him to provide a “fix,” which I know will just lead to frustration for both of us.  All I really want is for someone to say, “it sucks, doesn’t it?” and give me a hug. And maybe be able to forgive how snippy I was acting just before dinner there.  I’m pretty sure that was the diabetes talking. Even though no warning lights were blinking.

The blogosphere is on fire of late about a new ad campaign designed to devilify High Fructose Corn Syrup.  (See Kelly Kunik’s F-ing Kidding Me post, and Scott Strumello’s excellent overview of this “Sweet Surprise” travesty).

The ad campaign, created by an agency owned by Omnicom Group (which I’m embarrassed to say also acquired the San Francisco agency I once worked for) is in part targeting “influential mommy bloggers.”  Have a look for yourself:

All that comes to mind is: How dumb do they actually think we are?

I keep flashing back to my recent reading of Michael Pollan’s book, The Omnivore’s Dilemma. He chronicles the transformation of America’s diet to a corn-fest, and provides some pretty convincing evidence that High Fructose Corn Syrup (HFCS) is “the prime culprit in the nation’s obesity epidemic.”

Makes a helluva lot of sense, considering HFCS didn’t reach the American market until 1980, about the time that our obesity problem started getting really big.  It’s about more than people just eating too much; they are eating the wrong things!

The ads try to convince us that HFCS is “natural” and just as “harmless” as sugar when eaten in moderation.

Allow me to deconstruct that argument:

1) There is no such thing as moderation, when HFCS has become so ubiquitous. HFCS now sweetens everything from juice to spaghetti sauce to toothpaste.  As Pollan notes, it’s lurking not only in syrups and shakes and sodas, but also makes up 13 of the 38 ingredients (yikes!) in Chicken McNuggets, for example.  And remind me, will you?  Why does a piece of chicken need to be packed with corn sweetener?!

As a person with diabetes, I try to stay away from foods that are obvious HFCS bombs.  But when you look into it, you discover that HFCS is hiding everywhere: in jars of pickles, Stove Top stuffing, baked beans and tomato paste.  What is it doing there, other than ruining our collective health?

2) HFCS is quite clearly UNNATURAL. Making it entails a convoluted chemical process that begins with genetically modified corn.  HFCS wouldn’t exist today if the big food conglomerates didn’t have the sophisticated science to break down commodities into their basic components and then put them back together again as processed food.

3) There is plenty of scientific evidence that HFCS is worse for your health than sugar:

“In soda, it has been found that by using HFCS instead of pure sugar it can make the soda 10 times richer in harmful carbonyl compounds. According to one study, carbonyl compounds are elevated in people with diabetes and are blamed for causing diabetic complications such as foot ulcers and eye and nerve damage. Another study concluded that foods with increased quantities of fructose stimulate the liver to produce triglycerides, promotes glycation of proteins and induces insulin resistance.”

Naturally, too much sugar can also be very damaging to our bodies, causing obesity, liver damage, heart disease, etc.  But scientific evidence also tells us that “the body processes the fructose in high fructose corn syrup differently than it does old-fashioned cane or beet sugar, which in turn alters the way metabolic-regulating hormones function. It also forces the liver to kick more fat out into the bloodstream.”

This is why so many nutritionists will agree that a bit of old-fashioned sugar in your diet is preferable to HFCS, if you have a choice.

In any case, it just pisses me off to think that our kids might grow up believing that it’s normal and “natural” for their foods to be packed with HFCS.

Luckily, there’s quite an outcry across the blogosphere and smart media over these ridiculous ads.  You want to speak up?  I would suggest contacting the Corn Refiner’s Association directly, to tell them where they can stick their misinformation.

Meanwhile, you can visit some good blogs on living HFCS-free:

Live HFCS Free

Stop HFCS

Per Friday’s post, last week I attended the Robert Wood Johnson Foundation’s big event on health design in Washington, DC. The day-long conference was a forum for nine design teams to showcase new technology-based health tools they’ve developed over the last two years under a special grant program called Project HealthDesign.

Among those sitting on discussion panels at this event were the Senior User Experience Designer from Google, Senior Program Manager of Microsoft’s HealthVault, and President and CEO of Dossia, a  consortium of large employers working together to improve healthcare for employees across the county.   No kidding. With this triad, the audience was expecting fireworks from the panel, as rivals Google and Microsoft were asked whether their companies were “at war” over dominating the market for online health tools.

But in fact all we got from the good-natured representatives at hand were sheepish grins and shoulder-shrugging nods over whether data from their respective health sites would one day be interoperable. Que sera sera?

In any case, I wanted to share three (more) significant takeaways from the event that helped me make sense of the whole “PHR/A” (personal health records/applications) discussion:

1) It’s a lot like iTunes

Patti Brennan, Director of Project HealthDesign, says it’s all about “fundamentally rethinking something of value and repacking it in a way that enhances its accessibility to people.” Like what iTunes did for music:

“To me, PHRs are quite a bit like iTunes. There are musicians that make the music. There are record companies that distribute the music. There is iTunes that provides a different kind of platform for distribution. But in providing that platform, they actually have broken apart CDs so that users only have to take the pieces they want. You don’t have to buy the entire album, just the songs you want. And iTunes offers other important services. They keep track of the music and movies you purchase. They recommend other songs you might like. So this idea of many players in a distributed market of health data suggests that there would be incentives, first of all, for creating various kinds of repositories and action tools, and they might vary quite a bit.”

“So institutions…have an incentive to have good data management, because health data is a capital resource for the institution. But there are other reasons why a company such as Google might want to get into managing health data. Maybe it’ll draw more people to their site, and they can refer other sources or other products to them.”  Right.

2) Privacy = patient control

The big issue of privacy with online health records/tools is about more than just locking down computer security to keep hackers out. It’s about “patient control over data access at the level of the data element, not at the level of the data,” Brennan says. Here’s an example of what she means by that:

“Right now, if I give my physician permission to see my medical record, he sees the whole record. But I might want my gynecology records limited to only my women’s health practitioner and no one else, because I don’t think anyone else needs them… If I’m keeping really close track of my menstrual cycle and my sex life for a discussion with my clinician, I don’t necessarily want that shared with my dentist. And so being able to assign permissions on the level of data elements is really important.”

She adds: “This is pretty complicated, and it gets burdensome to patients. Yet, it is important and that is why we have spent so much time working on the common platform and its role in advancing patient-centered PHRs.”

3) Size of your file: TBD

Have a look at this thoughtful post at the Project HealthDesign blog.  Blogger Lygeia R. muses over a recent Washington Post article called Bytes of Life, which “explores the proliferation of new digital sites and services to help people record and analyze nearly every aspect of their bodies and behaviors.” (She notes that “data junkies” can find links there to sites that let users track geographic location, Internet use, menstrual cycle, and yes, even your sex life.)

But how much information is useful, and how much is just too much?

Clearly, we’re all still struggling to understand how much health data is necessary or sensible for certain health purposes.  There’s mention of how collecting data helps us to be objective and avoid the “halo effect” — unrealistically positive perceptions of our own behaviors. For example, the way keeping a food diary can be eye-opening about your real eating habits.  A good short-term application, that.

Diabetes is certainly one of the health conditions that can benefit most from “personal data collection” over a longer period of time. But diabetes is pretty darn intense to manage anyway. And it never stops. So data collection can become a major albatross. How often and how long do we have to “log” to get anything out of it?

All of which makes me wonder, Dear Readers: How do you think some sort of digital health tool could help you most?  I’m guessing that what makes sense to some people may be nonsense to others.  I haven’t quite figured out what my dream diabetes application would look like either, or at least nothing that seems to be the least bit realistic (just automate my glucose control, pleeeaaassse!)

On Wednesday of this week, I was privileged to attend the Project HealthDesign Expo in Washington, DC.  Not only to attend, but I was invited to deliver the lunchtime keynote address.  It was an amazing experience to stand up in front of 200 health experts from industry, government, academia and advocacy organizations and talk about living with diabetes.

What I told them essentially was what I believe advancements in medicine and medical technology mean to real people with real illnesses: they represent the chance not only to survive, but to live healthy, productive, and enjoyable lives. But at the same time, there are so many people with diabetes (and other burdensome conditions) out there struggling just to make ends meet.  Fancy new technology is not helpful for people who have no access to it.  I hope to post the video of my talk here as soon as it’s available.

So that’s what I had to say.  Meanwhile, the day was packed with presentations of innovative designs for new personal health record (PHR) applications and thought-provoking panel discussions about how tools like these can help Americans better “take charge of their own health.”

Some of the most impactful things I heard that day came directly from leaders of the Robert Wood Johnson Foundation, the high-powered healthcare non-profit behind Project HealthDesign.  The Foundation was established by the man who founded Johnson & Johnson Company (he left virtually his entire personal fortune to this group).

Allow me to share five key things I heard at HealthDesign:

1) “The days of the old metal racks of medical records are officially dead” (although I personally still see them in various doctor’s offices — my kids’ pediatrician and my opthamologist, etc).  All medical records are now going — or have gone — digital, and the new frontier is who can access this information and how.

2) “It’s not just about powering up your PC and viewing health data” … it’s about what you do with this information.  It’s also about accessing health info from your cell phone or other device when you’re on the move, and using it to make real-time health decisions.  Thus the term “PHR” for “personal health records” is likewise dying, because it’s not just about records anymore.  The nine teams working in Project HealthDesign were shooting for something they’re calling “PHAs” or “personal health applications,” like a touchscreen tablet that helps seniors make sense of their various medication bottles, or a cellphone alert service to remind kids with cystic fibrosis to take their medications regularly.  (Read specifics on the projects HERE)

3) “Health information is powerful, but it’s not yet in the hands of the people who need it.” Honing in on the access issue, health designers are recognizing that medical institutions have “locked up” people’s critical health information for too long, and that this is still the case for the most part.  So it’s all about unlocking this data, while safeguarding people’s privacy.  Tricky, but doable, they say.  Note that all of this buzz you hear about cellphone-based programs that let you share glucose data with your doctors is exactly that: a key to unlocking your health records so that you can use them to improve your own health.

4) “We need a common platform.” Of course we do!  Just like USB technology allows us to use a variety of devices with our computers and cellphones, we need health technology that’s interoperable.  And it’s great to know that Project HealthDesign had a team specifically assigned to developing a set of software components that can eventually be offered up to the open source development community (free for anyone to develop applications on).  If you’re a developer-type interested this background technology, see the set of specifications developed by experts Sujansky & Associates HERE.

5) “A lot of this is visionary. Especially for diabetes tools, we have a ways to go.” This shouldn’t be discouraging, but rather an affirmation of the fact that diabetes management is pretty freakin’ complex. There are so many factors interacting: your food intake, exercise, medications, duration of insulin action, other illness or stress, etc., etc.

Two of the design teams here developed prototype tools for diabetes management.  One was a garden-variety application to wirelessly upload data over a cellphone.  The other was a concept for a comprehensive computer-based program in which the patient will input a load of data on the aformentioned factors (food, activity levels, sleep, etc.) and the system will supposedly crunch this data into “specific recommendations for improving your typical routine.”  They even aired a video showing a guy receiving a text message alerting him that his glucose might be getting low during a run.  It also showed how the system helped him “seamlessly” eat cake — without a BG spike in sight.  Clearly, not a realistic scenario just yet.  But this development team, with the big aspirations, originates from the Joslin Diabetes Center (now working through the TRUE Research Foundation in Washington, DC). I’m sure that they “get it” (understand the limitations), and that they’ll be making incremental progress towards tools that actually help PWDs.

On the whole, an interesting and inspiring day.  Stay tuned: I’ve got a few more related observations to share with you all next week.

If you don’t know about Kelly Close and her work in the diabetes industry, you’re definitely missing out.  She’s a Type 1 herself, a former Wall St. analyst, smart as a whip, and just about the sweetest person you could ever hope to admire.

A Guest Post by Kelly Close, diabetes industry consultant

We recall our grandparents talking about their first experience watching “moving pictures” — for that generation, a revolutionary development from still photographs. But that technology is quite primitive compared to the visually stunning pyrotechnics that are featured in theaters today.

In the diabetes world, we will someday recall self-monitoring of blood glucose (SMBG) with the same quaint fondness that our elders remember those early moving pictures. SMBG was indeed a revolutionary technology (in this case, from the poor proxy of urine tests), but home glucose monitoring was the equivalent of still shots, and we are now inching our way toward the moving pictures of continuous glucose monitoring (CGM).

We try to be cautious in forecasting how quickly any new technology will be adopted, but in the past week or so, the results of an important study has been released that make us have a more optimistic take about the acceptance of, and reimbursement for, CGM.

We were thrilled to see exciting news from the European Association for the Study of Diabetes (EASD) conference last week, which was simultaneously reported in the New England Journal of Medicine.  Researchers reported the results from the JDRF CGM trials, showing that CGM use in adults resulted in a -.5% drop in A1c over six months for adults with about an 8% A1c baseline. That improvement is critical because many payers have been reluctant to cover CGM partly because there is not enough “medical literature” showing the merits of CGM — this literature is the best you could do — the New England Journal of Medicine!

The trial funded by JDRF and supported by all the manufacturers showed that in addition to a better A1c, there was also a corresponding rate of decreased hypoglycemia at the same time as A1c decreased, which we are all cheering about.  Many will remember the landmark DCCT trial that showed intensive control caused lower A1c but with lots more hypoglycemia, especially severe hypoglycemia. While this trial included highly motivated patients with extraordinary health care teams and incredible psychosocial support, we hope it will serve as a model around the world to help patients seek better control — and that it will do a lot for insurance reimbursement!

We know that CGM use isn’t for everyone, particularly for people who aren’t yet ready to deal with its body image issues, and it’s certainly far from being hassle-free. CGM also takes a lot of support from the health care team, so it’s pretty hard to go on one if you are isolated or don’t have a doctor or educator who sees its value. This trial didn’t find, by the way, that CGM yet caused significant A1c reductions in teens or children – then again, teens used the devices only 30% of the time and children only 50% of the time — like that lotto tagline: “You can’t win if you don’t play.”  Here’s to improving devices so that more people play.

On that note, we believe that CGM can be the same type of transformative technology that home glucose monitoring was, if the device companies work to make the technology more patient-friendly.  We know that improvement with the devices — more accurate, smaller sensors, less painful insertion methods, etc. — will accelerate their use. And while we often hear from patients who’ve been denied reimbursement (sign Gina’s amazing petition if you haven’t already), coverage is actually moving faster than we had expected. For example, Medtronic estimates that the majority of its sensors sold last quarter were reimbursed — that’s progress! Now let’s get that to nearly all…

We know that we are fortunate to live in a country where these devices are even available. Many places around the world struggle to maintain basic insulin supplies.  Our expectations are high as we eagerly await the advent of more combined devices (pump + CGM + who knows?) and more patient-friendly tools.

The show has just begun.

*    *     *

Kelly Close is editor of diaTribe, a free online diabetes newsletter focused on research and new products, and President of Close Concerns, a healthcare information firm focused on the business of diabetes.