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CGM with Dexcom: A life-changing device for Michael

PPP spoke with Shay Speakman-Brown, Head of Market Access at Dexcom, and Michael Lawrence, a CGM user and part of Dexcom's Warrior programme, to understand the transformative effect that continuous glucose management technology can have on individuals with diabetes as well as the wider healthcare system.

By Navodi Kuruppu

Diabetes UK has reported that 4.9 million people in the UK live with diabetes, with an additional 1.2 million people that could be living with type 2 diabetes (T2D) who are yet to be diagnosed. With rapidly increasing numbers, many T2D patients around the country are relying on continuous glucose monitoring (CGM) devices to support the management of their diabetes care. With various providers on the market, DEXCOM is a pioneer in CGM, helping people’s daily lives, empowering them to live confidently and feel more in control.

Public Policy Projects’ (PPP) Director of Market Access and Policy, Ameneh Saatchi, had the opportunity to talk with Shay Speakman-Brown, Head of Market Access at Dexcom and Michael Lawrence, a Dexcom CGM user who is part of the Dexcom Warrior programme. Through this programme, people with lived diabetes experience like Michael can share their stories in partnership with the company.

This was an opportunity to directly listen to a patient’s story with diabetes technology, how their life has been changed thanks to the device and what indirect challenges they face and what the system could do to improve access to technology for T2D individuals. With Michael and Shay’s inputs, PPP collected a series of insights on T2D individuals around inequality of access to diabetes technology, perpetual stigma of this specific type of diabetes, the need for expanding criteria guidelines, and most importantly, a need for stronger education on diabetes technology within primary care and among healthcare professionals (HCPs).

Michael, 55, works as a solicitor for an in-house chain of decorators in Eastbourne. In 2011, his life dramatically changed when he was diagnosed with T2D. While the diagnosis did not come as a surprise due to his family history, the diabetes care routine that followed meant an all-hands-on deck approach by Michael. For the following ten years, Michael would use a finger prick glucose monitor to check his blood sugar levels two to three times a week and regularly take metformin, an antidiabetic agent that manages high blood sugar levels, as well as other drugs. On top of this, Michael had to rigorously manage his diet, exercise, and stress levels, often on his own account. Despite the rigorous management of his diabetes, his condition got worse, and noticing discrepancies in his blood sugar results led Michael to feel disoriented with the direction of his diabetes management.

“I was left to my own devices in terms of working out the right diet. It was really something I was just to do on my own. To me that situation led to long periods of just giving up and not really making much of an effort.” – Michael Lawrence, Dexcom CGM user and part of the Dexcom Warrior programme

These circumstances took a positive turn in February 2022, when Michael decided to invest in a CGM system with Dexcom and started using insulin. With this new procedure, Michael has been able to keep his HbA1C at a stable level of 31, making the process of getting the right doses of insulin easier and more effective. He feels the Dexcom CGM helped with gaining a sense of direction with his glucose levels, which made a “huge difference” for him, particularly in the evenings. Also, Michael was persistently suffering from severe hypos, a situation where one’s blood glucose levels drop too low, usually occurring during sleep. With Dexcom CGM working 24/7, Michael and those around him experience improved domestic harmony and well-being, significantly reducing stress for all.

“The CGM makes a huge difference, particularly in the evening after meals. When sleep follows, that’s the most concerning time. But now I have peace of mind and feel a sense of control in that there is an alarm that will sound if glucose levels are irregular. With the CGM I’ve got a much better chance at getting the doses right. The CGM also has an alarm which give some peace of mind and sense of control.” – Michael Lawrence

However, Michael self-funds his device, which alongside managing his diet, exercise, and insulin without doing finger prick testing, can often be “overwhelming”. If he could no longer afford it, Michael feels his life would be significantly impacted, affecting not only his ability to exercise, but also to perform simple physical activities like taking a walk after dinner. He would also have to avoid long drives and have someone with him at all times when making long drives, putting a lot of aspects of normal life out of reach. Throughout the interview, Michael often acknowledged his unique position where he can afford to fund his CGM, and stated that anyone who can afford it, should get a device of this kind.

On being asked about what primary care should improve, Michael explained that education on diabetes technology should be a pillar of primary care diabetes management, saying that information given by HCPs should not be limited to just diet and exercise advice. They should be speaking to patients about the options available to them, and whether or not they can be funded by the NHS. The reason he did not rely on primary care for getting a CGM is because the option was never suggested to him, even on a self-funded basis. Primary care could be more open to the use of these technologies, and Michael felt that his GP team was quite sceptical, and that he had to convince them about the benefits. However, after seeing the results, his GP team strongly recommended he continue to use CGM.

Challenges within primary care are not limited to gaps in research and a lack of knowledge sharing on diabetes technology. The eligibility criteria differ for type 1 diabetes (T1D) and T2D patients, where T1D is treated as a condition that requires immediate application of technology. In this way, the existing criteria further deepens inequalities in access between the two patient groups.

On this theme, Shay commented to address how these criteria may drive misguided behaviours within the health system. The latest NICE Technology Appraisal Guidance (943) will enable robust criteria for T1D people with diabetes to access these systems.2 However, the criteria remains significantly restricted for T2D patients, which would require them to have two or more injections of insulin per day and experience severe hypoglycaemia and/or impaired awareness. Shay also explained that a referral for technology at a GP can take a long time and may only happen after a medical event like severe hypoglycaemic event. This can drive inequalities between T1D and T2D because they may be considered as the same condition or as one, while the mechanics of epidemiology of the two conditions are quite different. The inequality of access between T1D and T2D may be driven precisely by the previously discussed lack of education. Shay also shed light on the possible fears at commissioning level about the number of T2D patients that may apply for CGM, with concerns about a lack of supply. However, CGM has been proven to be successful in preventing complications and reducing the long-term healthcare costs of managing T2D.

“Having a sensor and preventing one trip to hospital or one incident can actually give [the NHS] return on the investment for the sensor.” – Shay Speakman-Brown, Head of Market Access, Dexcom

Despite being predisposed to the condition, Michael often inferred from clinicians that he was partly to blame for it, due to an unhealthy lifestyle. The difference in rules for T1D and T2D was not explained to him leaving him feeling excluded due to his specific condition. He believes that an open conversation between primary care and a T2D patient can tackle the stigma and help lessen feeling of judgement.

On the patient voice, Shay touched on Dexcom’s the robust education programme in place for HCPs, which features extended access to webinars. Dexcom also holds events with T2D “warriors”, who act as be ambassadors for patients, their cause, and CGM technology.

“Success stories like Michael’s can support the health and economic outcomes and allow the system to grow holistically.”- Shay Speakman-Brown

On the holistic aspect of care, Shay highlighted the importance of treating the whole patient, considering their mental, physical and emotional wellbeing. She explained that each T2D case has its own unique “footprint”, and CGM data operates in a way that reflects this. For example, on the occasion of a patient requiring an operation outside of their diabetes care, CGM data can be extremely useful as it can be stored in the electronic patient record, allowing decision-making to consider the whole patient, not just a single condition. In addition to patients’ benefits, the availability of CGM data optimises the use of resources within the healthcare system, leading to better outcomes and increased availability of services.

For the data to be effective however, Shay emphasised the importance of data literacy and the ability of HCPs to correctly interpret the data.

Dexcom is also exploring new paths of diabetes care improvement, including the possibility for more remote monitoring, so that patients can have regular contact with healthcare providers without having to travel. Shay concluded by stating:

“We must remain focused on helping the person with diabetes to be heard – that’s the core of everything we do. We want to drive education at primary care level, alongside patient education and awareness. We want to highlight the availability of technology for people with T2D and its benefits, as well as continuing to hear and support the patient voice. We also want to support the expansion of the guidelines to enable people like Michael to avail themselves of technology on the NHS.”

If you are a patient or a healthcare professional who wants to find out more information about CGM technology, visit the Dexcom website here.

Throughout the 2024 Diabetes Programme, PPP had the privilege to connect and speak with more 150 diabetes experts and explore themes including prevention, unmet needs of patients, inequalities, and stigma in diabetes care. To end this programme, we look forward to seeing national thought leaders at our Autumn Programme, which will focus on not just treating diabetes, but providing holistic, patient-centred care. With four virtual 90 min invitation-only roundtables, the programme will bring together a broad range of health and care experts to elevate the shared understanding of challenges and opportunities for prevention of diabetes complications and improving outcomes for people with diabetes and other metabolic conditions to improve access and outcomes through better diabetes services.

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