Joslin Diabetes Center's Evaluation Of CGMs

A senior physician in the Joslin adult clinic and assistant professor at Harvard Medical School, Howard Wolpert, M.D., examines the best ways to adopt technology for type 1 diabetes management.


http://www.joslin.org/news/q&a_howard_wolpert_MD_on_CGM_in_clinic.html

Interesting article. When I went to some of the classes, none of the patients were using a CGM (this was the pump class and the CGM class). So to say only 550 patients have the CGM out of how many total patients. This is what I would like to know to get more data that GM helps patients as he has said in his article

Thank you for posting that Richard. I do agree with the benefits of having a CGMS and am I glad to see that he recognized that, but I disagree with several things that he said.

One of the things that he said was ”For example, we uncovered that people who are focused on examining their glucose data retrospectively did much better.” I really disagree with that. I have gastroparesis and I can do the exact same thing 7 days in a row and get 7 totally different results. I do eat the exact foods ever day with very few exceptions. To keep my BS in good control, I stay on top of what is going on with my BS now, not what happened yesterday. I use the alarms on the Dexcom to alert me when my BS is out of range or changing directions quickly. I do make very good use of my Dexcom but I don’t look at data “retrospectively” because what happened yesterday is pretty much useless to me. I have a friend that uses the Dexcom for her daughter and she does not download data to look at but makes decisions in the now. She also does quite well with her daughter’s care.

I also partially disagree with the statement “Another issue we identified was that the way people respond to frustration is a predictor of whether they do well or not with CGM. People respond in a stoical, self-controlling manner tend to do better than people who get frustrated and anxious and angry. “ I can see if someone gets easily frustrated that they won’t do well with a CGMS like Minimed that takes a lot of work to get to work properly, but the Dexcom is very easy to use. The Dexcom can have some annoying moments but it is not like someone has to be frustrated every single day to use it properly.

I don’t know if the frustration is towards getting the CGM to work, or getting your numbers in range. I know I have to do one week on/one week off to keep myself from obsessing over the numbers. I find myself a lot more overwhelmed with diabetes when I use the CGM, even though I also love the information it provides, just because I know exactly what is going on with my sugars. It can be hard to live your life first and have diabetes second when you have a beeping, screeching, vibrating device telling you “your doing it wrong” 5, 7, 9 times a day.

Kelly, I understand your disagreements. I didn’t agree completely with the messages either. People had written with questions and those were the doctor’s replies.

I hear you Maia, it was that way for me in January. That was my first month with a CGM. Then I found this Dexcom Users group. I learned many things that were not in the manual. Now I can use a sensor for two weeks or more, and have very reliable numbers about 80% of the time.

You are probably right, I did not even think of it as being that kind of frustrated! I don’t look at it as it telling me I am doing something wrong but instead, it tells me something is going wrong & I can fix it before it gets as bad as it would with regular testing.

I didn’t realize that it was question/answer type thing. I am glad that he at least supported it and agreed that the directional arrows are a big plus in making decisions.

I thought the article was a good one. And I kind of agree with both viewpoints regarding the retroactive analysis and the frustration bit.

When I think of those who are limited by frustrations what comes to my mind is those people who are frustrated by the the lag time time, the 20% accuracy of meters, not recognizing that this technology is in it’s infancy, or not being able to accept what it can and cannot do etc. Or finding that the reality of CGMS is so different from what they expected it to be that they just can’t adapt. Sure there are things I wish the CGMS did better but I pretty much accept it is what it is right now and I’d rather focus my energy on what it can do for me today warts and all rather than what I want in the future. One disadvantage of being an early adopter of new technology is you get to be the guinea pig and it won’t be perfect. I can deal with that whereas other people will be too frustrated and will see more negatives than benefits.

The other thing I’ve learned wearing CGMS is that it doesn’t help to get upset if your blood sugars are out of whack. If I can figure out why I’m high or low then great I’ve got an idea of what to do next time to prevent it. If I can’t figure it out that’s ok too it’s the evil diabetes fairies fault. Either way the solution for me is the same you treat and move on about your day.

I find downloading and looking at data retrospectively to be helpful. Too often the days blend into one another and it all gets jumbled in my mind. I often find that what seemed to be a big problem is really only happening infrequently or what I thought was just a fluke is starting to turn into a pattern and instead of using temp basal or corrections I would be better served by upping my insulin to carb ratio. Stuff like that. I also find it easier to adjust basal rates after looking at several days of data. Works for me.

Diana

Thanks, your view is the same as mine. I had no particular expectations before I started using my Dexcom. It was an unknown. I have found many positives and I appreciate them so much.