Global Leaders Discuss the Future of CGM and TIR
By Arvind Sommi
At diaTribe’s Solvable Problems event in Berlin, we heard from esteemed physicians about their thoughts on the use of technology among people with diabetes.
diaTribe’s Solvable Problems in Diabetes event, held during the Advanced Therapeutics and Technology for Diabetes (ATTD) 2023 conference in Berlin, Germany, focused on the future of technology use in diabetes and Time in Range.
Topics included the importance of starting technology soon after diagnosis and barriers to accessing these technologies. The panel, moderated by Professor Tadej Batellino, the co-chair of ATTD, introduced four leading female physician-researchers from around the world:
Professor Ananta Addala – Pediatric Endocrinologist at Stanford University, USA
Professor Chantal Mathieu – Endocrinologist at Katholieke Universiteit, Belgium
Professor Elaine YK Chow – Assistant Professor at the Chinese University of Hong Kong
Professor Emma Wilmot – Endocrinologist at the University of Nottingham, UK
Diabetes technology has come a long way, and continuous glucose monitoring (CGM) is one such technology that is rapidly gaining popularity. As Professor Mathieu noted, the use of CGM is likely to revolutionize diabetes management, and “in five years, we may soon forget the days when we pricked our fingers to test our blood glucose levels.”
Likewise, Chow noted, “Time in Range will become increasingly important, especially as we use Time in Range as an endpoint in clinical trials.”
When should we start using CGMs?
The question of how early to start someone on a CGM was an important topic of discussion. Mathieu explained how some of her colleagues still believe that patients should start with two to three days of finger pricks before moving on to CGM. She saw this perspective as analogous to the discussions that occurred when insulin pens first became available and some doctors insisted that patients begin injecting insulin with a syringe first.
Batellino and Mathieu joked that this was also similar to having to drive with a stick shift before starting with an automatic, even if one’s car was an automatic. Mathieu is confident that in a few years, we will not even consider waiting to start CGM as an option.
The panelists all agreed that CGMs were beneficial at both an individual and societal level. Battelino began the discussion by sharing that studies have shown that CGMs are cost-effective and that “we don’t discuss this angle enough with the public; perhaps we should.”
Mathieu qualified Battelino’s claim by reminding the audience that determining cost-effectiveness can vary greatly from country to country, citing the exorbitantly high healthcare costs in the United States.
Wilmot mentioned how CGMs enable her to support her patients, “Diabetes is really complicated. It is one of the most challenging chronic conditions to manage, and we want to support people and help them feel like they are achieving their goals.”
Chow added that “with CGM, people have more ownership over their own diabetes.”
Disparities in diabetes technology
Throughout the panel discussion, access to diabetes technology was a recurring topic. Addala framed this discussion, “There is always going to be a cutting-edge of technology, but there is also always a whole group of people not getting enough technology and those left behind.”
Addala called on device manufacturers to become more linguistically and culturally accessible and for clinical trials to be more representative of the overall diabetes population. Batelino mentioned that perhaps access would be improved dramatically if the Apple Watch featured a glucose sensor. However, Mathieu noted that this technology is likely still years away from being commercially available. Likewise, Addala pointed out that not everyone can access an Apple Watch and that we need even more affordable solutions for underserved communities.
Mathieu concluded by summarizing the overall message of the Solvable Problems panel, “I believe we are just at the beginning of this new technology.”