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.
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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.
Hi Kelly
I look forward to the day when CGM devices are smaller, easier to use, and covered by medical insurance. It will come, it just takes time and constant advocacy work.
All the device makers seem to focus primarily (exclusively?) on passing FDA requirements. Many of them seem to have forgotten that we’re also people and that there are many ways to improve our experience with devices that we need to live our lives. I’m hoping that this too will change.
Are you coming to the DRI meeting in New York next month? If so, I hope to see you there.
i WISH i were going to the DRI meeting in NY – i will be at a wedding in SF that weekend! there will be so many great things there i know and i’ll be psyched to read about it from you and Amy! i’m going to be sure to pass on your sentiments about focus – for sure improving experience further will be key to expanding this market. thanks again for your thoughts and good luck at the triathelon!
I think the comment “people who aren’t yet ready to deal with its body image issues” really ought to be turned around. It’s not me who’s not ready to deal with it, the equipment needs to advance so that it doesn’t cause unacceptable body image issues in the first place. Right now the kit is ugly, obtrusive and a constant reminder to yourself and others of your diabetes. Personally, I don’t deny my diabetes, but I keep it in the background of my life. I’m a type 1 with a 6.0 A1C and for me so far that has been possible. Sticking one of the current gadgets onto myself turns that on its head – I’d much rather stick with finger pricks and in between them have a body unfettered by high-maintenance diabetes paraphernalia.
I am excited to here the news and I hope insurance companies stop thinking about the “almighty dollar”. I am excited and waiting for omnipod to offer the CGM. thank you for the info
We’ve come a long way since the Greek diagnosis of diabetes by urinating in a bowl – and if it attracted bees, being told “you’re going to die soon.”
Boiling glass syringes to sterilize them gave way to disposable plastic syringes, and the needles keep getting smaller. If they were this small when I first tried to give myself a shot as an 11 year old, I might actually have got some of the insulin under the skin..
We have items like the medijector (I list syringes as my only allergy on doctor’s forms.. 
and now various forms of insulin pumps available.
We went from $12/bottle beef and pork insulin (which is what the docs blame the hard skin layers on the top of my legs on) to $30/bottle rDNA insulin (Novalin/humalin) to $70/bottle (humalog/novalog)..
And the testing equipment follows suit. Now if this continuous monitoring can be made smaller, less intrusive, more real time, more accurate, and much less expensive so more diabetics can afford it, life will be much better.
Here’s hoping the next few generations of continuous monitoring are developed and released a bit faster..
Hi Kelly,
I bought a CGM out of pocket about 6 months ago. I thought that I would have the peace of mind that I could check my trend while out and about, and know what needed to be done. The reality was a different story. I had quite a number of false lows, inaccurate readings and nighttime alarms that were way off base. Now please don’t get me wrong, I understand that CGM is truly in it’s infancy, and many adjustments and improvements need to be made.
This past September 18th, my brother was killed while sitting at a light on his motorcycle. He was hit from behind by a drive doing approximately 60 miles per hour. This driver didn’t even hit his brakes. When taken out of his car, the man didn’t even know that he had killed someone. It turns out that the dirver was in diabetic shock! Perhaps if he had a CGM, he would have known to pull over and treat it. If so, my borther would be alive today. Maybe not. The lesson here is that there is a need for a second gen CGM to be developed that is more reliable to prevent such needless tragedies such as my brother’s death.
Wish you well,
Ben Gubar