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Could AID Transform Type 2 Diabetes Care?

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While AID has traditionally been used in type 1 diabetes, new data suggests this technology has many of the same benefits in type 2 – namely, improving time in range and A1C while reducing hypoglycemia. Plus, AID dramatically simplifies blood sugar management. 

From continuous glucose monitoring (CGM) to automated insulin delivery (AID) systems, diabetes technologies that began as innovations for people with type 1 diabetes are slowly beginning to reach people with type 2.

For instance, many insurance companies now cover CGMs for people with type 2 diabetes who take insulin as well as those who are not on insulin but have a history of hypoglycemia. And earlier this week, the FDA approved Stelo by Dexcom, a CGM designed specifically for people with type 2 diabetes who are not taking insulin.

However, less progress has been made with reimbursement by insurance companies for AID. Off-label use of AID drew significant attention at the ATTD 2024 conference, with presenters highlighting the benefits for many people with diabetes across a range of settings and systems.

AID improves time in range across different systems and settings

Research shows that AID leads to many of the same benefits in type 2 diabetes as in type 1 diabetes: improved time in range, reduced hypoglycemia, and reduced A1C. Importantly, these benefits were consistent across different study settings and regardless of which AID system was used.

A study of 30 Tandem Control-IQ users with type 2 diabetes found that time in range increased by about 15% from 56% at baseline to 71% at six weeks. This translates to an increase of 3.6 hours per day spent in range.

Dr. Anders Carlson, diabetes medical director at the International Diabetes Center in Minnesota, said this finding is in line with studies in type 1 diabetes as well as the time in target range guidelines for type 1 diabetes.

Outside of clinical trials, research suggests that the benefits of AID extend to people with type 2 diabetes in the “real world.”

In a study presented at ATTD, MiniMed 780G users were able to achieve 71-75% time in range outside of a clinical trial, again meeting the targets for diabetes. “This is really compelling evidence that in a real-world setting, this AID system can work for people with type 2 diabetes,” Forlenza said.

Participants who used the recommended MiniMed 780G settings (i.e. the lowest glucose target) achieved a time in range of 80%.

For Carlson, this finding raises an important question – what are the optimal settings for AID in type 2 diabetes? For instance, since low blood sugar (hypoglycemia) is less of a concern, it may be beneficial to have more aggressive targets from the get-go.

Another study investigated the Omnipod 5 AID system in 24 participants with type 2 diabetes, finding strong improvements in time in range with minimal hypoglycemia. Among those on MDI, time in range increased from 43% at baseline to 58% at six months. Participants on basal insulin only saw even larger improvements in time in range, from 31% at baseline to 65% at six months.

Dr. Anne Peters, professor of medicine at USC, also highlighted reductions in total daily insulin dose among participants on MDI – yet another way in which AID could simplify type 2 diabetes management.

How might combining AID with GLP-1s and SGLT-2s affect glucose levels?

Growing use of GLP-1 receptor agonists, SGLT-2 inhibitors, and diabetes technology poses new questions for the future of diabetes care. That is, how might the combination of technology and medications optimize outcomes for people with type 2 diabetes?

In the Omnipod 5 study, half of the patients were also taking a GLP-1 or SGLT-2. Overall, Omnipod users taking a GLP-1 or SGLT-2 saw greater improvements in time in range compared to those who were only taking insulin. Participants in the GLP-1 or SGLT-2 group saw a 24% increase in time in range from 28% at the start of the study to 62% at eight weeks. Meanwhile, participants not using a GLP-1 or SGLT-2 improved their time in range by 18%, from 35% at baseline to 53% at eight weeks.

Carlson said this finding suggests that combining GLP-1s or SGLT-2s with AID could potentially lead to even better glycemic control than AID alone – though formal studies will be needed to test this hypothesis.

Similarly, Dr. Gregory Forlenza, associate professor of pediatric endocrinology at the University of Colorado, noted the ability of GLP-1s to reduce insulin needs. Combining these powerful medications with AID may help people with type 2 diabetes improve glycemic control and lose weight. It’s possible these improvements could even help people work toward diabetes remission.

What about AID for older adults with type 2 diabetes?

Starting insulin can be challenging for people of all ages, but it can be especially complex for older adults or disabled people with type 2 diabetes who receive home care.

Elderly people have a higher risk of severe hypoglycemia and hypoglycemia or ketoacidosis. Diabetes management for older adults can also be complicated by impaired cognition or dementia, reduced mobility, and difficulty accessing care.

In this context, the CLOSE AP+ study investigated AID assisted by nurses in people with type 2 diabetes unable to manage their own multiple daily injections (MDI) at home. CLOSE AP+ tested Control-IQ technology in 25 participants who had an average age of 70 years.

At 12 weeks, time in range improved significantly, from 37% to 63%. Time below range was less than 1%, while time above range was under 10%. Overall, Reznik highlighted that a majority of participants reached the American Diabetes Association guidelines for older people with diabetes. These guidelines recommend:

  • At least 50% time in range (70-180 mg/dL)
  • Less than 1% time below range (<70 mg/dL)
  • Less than 10% time above range (>250 mg/dL)

It’s also worth noting that participants using Control-IQ technology saw a significant 1.3% reduction in A1C. Over 90% of participants reached an A1C of less than 8% by the end of the trial, without any increase in severe hypoglycemia. Dr. Yves Renzik, professor of endocrinology at CHU Caen Normandy in France, also highlighted high patient confidence and high nurse satisfaction with the AID system in this study.

Ultimately, the CLOSE AP+ study showed that AID can be used safely in people with type 2 diabetes who require home nursing care. This confirms the benefits of AID extend beyond the “standard” person with type 2 diabetes to older adults and people with disabilities.

The bottom line

Numerous presentations at ATTD 2024 demonstrated that AID is safe and effective for people with type 2 diabetes. Both clinical trials and real-world data show that this technology increases time in range and improves A1C while minimizing hypoglycemia.

“I want to emphasize that across a wide variety of real world and clinical trial evidence sets, and across very different AID systems, everyone is either doing a great job hitting a goal for time in range or achieving a massive improvement in glucose control,” Forlenza said. He noted that AID leads to time in range increases of 15% to 24% in people with type 2 diabetes, nearly double the improvements typically seen in type 1 diabetes.

However, several questions remain to be answered regarding optimal settings, bolusing, and the potential of AID when combined with GLP-1s and SGLT-2s. Carlson highlighted the following areas for further research:

  • Are people on MDI the only candidates for AID? Or could AID be used in all people with type 2, regardless of their insulin needs and whether or not they’re meeting glycemic goals?
  • Is previous experience with technology necessary for successful use of AID in people with type 2 diabetes?
  • Does AID help with diabetes self-management (such as carb awareness)?
  • What role will primary care providers provide in supporting AID in this population?

Beyond glycemic data, it’s also important to consider user experience with AID. Overall, the data suggests that people with type 2 diabetes had good satisfaction and confidence in using these systems. Even people who hadn’t previously used diabetes devices reported a positive experience with AID, Peters noted.

“I honestly wasn’t sure my patients would like AID – many were technology-naive people,” Peters said. “But they loved it and they wanted to stay on it because they felt it improved their glycemic control.”

Comparing the Accuracy of My Blood Glucose Meters

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I was first introduced to the One Touch Verio IQ when I began using an Animas insulin pump in May 2016. The sales rep gave me a rave review of this blood glucose meter, telling me that it was one of the most accurate on the market. This meter had also been recommended for calibrating readings on a Dexcom system, which is often considered the golden child of continuous glucose monitoring in the diabetes community.

At the time, I was quite happy with my FreeStyle Insulinx and had no intention of switching. However, the Verio was quite a good looking meter and certainly more modern than any of the other devices I was using. So, I ended up placing it in my travel case and decided that I would use it as my spare.

As wonderful as the encasing, color screen, and rechargeable batteries were, my biggest deal breaker in using this meter was its accuracy. I have consistently found that the One Touch Verio reads at least 0.5 mmol/L (9 mg/dL), if not 1 mmol/L (18 mg/dL) higher than each of my other blood glucose meters.

There have been times where I’ve felt lows coming on, only to check my blood sugar using the Verio and still see a reading within range. From my personal experience, this is not a meter that I can trust.

To be fair, all blood glucose meters will only be accurate to the nearest 1 mmol/L (18 mg/dL) of a laboratory result. Which explains why two simultaneous blood glucose checks will likely produce two different results.

Most blood glucose meters must have a mean absolute relative difference (MARD) within 15 to 20 percent of laboratory results. This standard deems these devices a reliable indicator of blood glucose levels and safe to dose insulin from.

Which blood glucose meter can I trust? I conducted an experiment of sorts at home comparing all of the blood glucose monitoring devices that I currently use. Pictured from left to right, these include FreeStyle Libre, OneTouch Verio IQ, Accu-Chek Guide, and FreeStyle Insulinx. (Note: The FreeStyle Libre is a flash glucose monitoring system that measures interstitial fluid, and produces a reading each time the reader is waved over the sensor worn on the upper arm.)

Given that any moisture or dirt on my hands can impact glucose readings, I washed and dried my hands thoroughly before lancing my finger and repeated this experiment three times.

  Lowest Reading Highest Reading Variance
Experiment 1 FreeStyle Insulinx (7.0 mmol/L) OneTouch Verio IQ (8.2 mmol/L) 1.2 mmol/L
Experiment 2 FreeStyle Insulinx (7.1 mmol/L) OneTouch Verio IQ (8.4 mmol/L) 1.3 mmol/L
Experiment 3 FreeStyle Insulinx (6.2 mmol/L) OneTouch Verio IQ (7.8 mmol/L) 1.6 mmol/L

The FreeStyle Insulinx produced the lowest blood glucose reading in each of my three checks, while the OneTouch Verio IQ produced the highest. Variances between the lowest and highest reading were fairly consistent, ranging from 1.2-1.6 mmol/L.

  Lowest Reading Highest Reading Variance
FreeStyle Libre 7.3 mmol/L 7.4 mmol/L 0.1 mmol/L
OneTouch Verio IQ 7.8 mmol/L 8.4 mmol/L 0.6 mmol/L
Accu-Chek Guide 7.2 mmol/L 7.6 mmol/L 0.4 mmol/L
FreeStyle Insulinx 6.2 mmol/L 7.1 mmol/L 0.9 mmol/L

When comparing the performance of each meter across my three checks, the Accu-Chek Guide reported the lowest variance among the standard blood glucose meters with 0.4 mmol/L. The FreeStyle Insulinx reported the greatest variance, with a 0.9 mmol/L difference between the lowest and highest reading.

I also decided to repeat my experiment a second time with an elevated post-meal blood sugar, as I had my suspicions that the variances might be greater.

Lowest Reading Highest Reading Variance
Experiment 1 FreeStyle Insulinx (10.3 mmol/L) OneTouch Verio IQ (11.5 mmol/L) 1.2 mmol/L
Experiment 2 FreeStyle Insulinx (10.6 mmol/L) OneTouch Verio IQ (12.7 mmol/L) 2.1 mmol/L
Experiment 3 FreeStyle Insulinx (8.7 mmol/L) OneTouch Verio IQ (12.1 mmol/L) 3.4 mmol/L

Once again the FreeStyle Insulinx produced the lowest blood glucose readings across my three checks, while the One Touch Verio produced the highest. Interestingly variances between the lowest and the highest readings ranged significantly higher than my first experiment, from 1.2 mmol/L to 3.4 mmol/L.

Lowest Reading Highest Reading Variance
FreeStyle Libre 11.1 mmol/L 11.3 mmol/L 0.2 mmol/L
Accu-Chek Guide 10.8 mmol/L 11.1 mmol/L 0.3 mmol/L
OneTouch Verio IQ 11.5 mmol/L 12.7 mmol/L 1.2 mmol/L
FreeStyle Insulinx 8.7 mmol/L 10.6 mmol/L 1.9 mmol/L

The Accu-Chek Guide again reported the lowest variance in each of my three tests, while the FreeStyle Insulinx reported the greatest variance. Interestingly, the OneTouch Verio and FreeStyle Insulinx showed significantly larger variances in this second experiment.

I thought it would also be interesting to compare the accuracy of each brand of test strip with laboratory results. This information can also be found on the information packets inside test strip boxes.

Glucose concentrations of less than 5.5 mmol/L (100 mg/dL):

  Within 0.3 mmol/L (5 mg/dL) Within 0.6 mmol/L (10 mg/dL) Within 0.8 mmol/L (15 mg/dL)
Accu-Chek Guide 94.1% 100% 100%
FreeStyle Lite 70.1% 95.5% 99.5%

Glucose concentrations of less than 4.4 mmol/L (75 mg/dL):

  Within 0.3 mmol/L (5 mg/dL) Within 0.6 mmol/L (10 mg/dL) Within 0.8 mmol/L (15 mg/dL)
OneTouch Verio 88.2% 100% 100%

Glucose concentrations greater than or equal to 5.5 mmol/L (100 mg/dL):

Within 5% Within 10% Within 15%
Accu-Chek Guide 71.5% 97.6% 99.8%
FreeStyle Lite 66.9% 91.1% 98.8%

Glucose concentrations greater than or equal to 4.4 mmol/L (75 mg/dL):

  Within 5% Within 10% Within 15% Within 20%
OneTouch Verio 71.1% 94.8% 90.0% 100%

All glucose meters were accurate within 15 or 20 percent of a laboratory result, likely meeting medical device regulations.

All meters showed greater accuracy among the lower glucose level classifications than higher ones. The Accu-Chek Guide also scored significantly better than the other brands at being within 5 and 10 percent laboratory result.

Interestingly, laboratory testing for the OneTouch Verio strips was classified differently from the FreeStyle Lite and FreeStyle Insulinx. The higher glucose level classification started at 4.4 mmol/L (75 mg/dL), compared to 5.5 mmol/L (100 mg/dL) for the other brands. In the higher glucose level classification, the Verio only reached near perfect accuracy at 20% of a laboratory result, compared to 15% for the other brands.

Feeling overwhelmed with all of this data? I think it is best not to get too caught up in the differences. Most meters are only accurate to the nearest 1 mmol/L (18 mg/dL), and two finger pricks will not guarantee you two identical results.

Stick with one meter that you feel comfortable with and that you feel you can trust. Ensure that your hands are clean and dry before lancing your finger and that you obtain a sufficient sample of blood. Finally, you will obtain more insight into your blood glucose data the more frequently you check your blood sugar. As the old saying goes, test early and test often!

The Latest and Greatest in Insulin Pumps and Sensor Technology

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diabetes pumps and sensors

I love pumps and sensors!

As a certified diabetes educator (or as I prefer to say, type 1 coach), I have started literally hundreds of patients on insulin pumps over the last few decades. I have a disclaimer: I do not wear a pump and do not have type 1 diabetes. But I have worked in the field from clinics to ski and summer camps, as a dog sled driver for little munchkins with our team of sled dogs, to backpacking and canoe trips – all with people who do have type 1 diabetes. Sometimes I grunt and groan when I get up to start an adventure, but then I meet up with the group and see someone taking shots! My emotions turn to glee when someone has a pump and a sensor…I realize it sometimes feels like being the bionic man or woman with all this technology but hey, what’s wrong with being such a diabetes stud or studdette?

So what is so cool about pump and sensor technology?

Well, if you’re like me and you like to participate in group sports or activities, the technology is amazing. Let’s say you are just starting off on an adventure (whatever that may be) with a group and you note on your sensor that your blood glucose (BG) is 50 mg/dL.

Argh.

Who wants to stop the whole team from proceeding? But then you realize you can take in some carbohydrates, lower your basal rate temporarily, and watch your sensor to see if you are coming up and are not only good to go, but where you will be in 5, 10, 15, 20 minutes…you get the idea.

What are the options available right now to help you manage your diabetes?

The Omnipod insulin pump is the only full functioning patch pump, meaning it is programmable with insulin-to-carb ratios, target BG, correction factors, etc. so your math is done for you. At this time, the Omnipod pump does not integrate with a sensor but you can certainly use the Dexcom sensor independently.

There are also two patch pumps that are not programmable and have a bolus only option (OneTouch Via) and basal/bolus option (V-Go). These are more likely options for those with type 2 diabetes.

The Tandem insulin pump does have a tube that most folks find a minor inconvenience. Its great new claim to fame is that, as the software is updated (and technology is changing so fast!), you can update your pump via the cloud. How cool is that! Your pump does not get outdated since the pump software is updated. This includes future changes, such as Dexcom sensor data on the screen, auto-suspend as needed with hypoglycemia, and the eventual goal of a fully integrated sensor and pump where the pump responds to the data from the sensor and alters insulin delivery.

tandem and dexcom cgm

The Medtronic insulin pump company has led the charge not only with a sensor integrated pump where the sensor data is seen on the pump screen, but where the pump responds to low blood glucose values and impending lows, and adjusts basal rates as needed based on your basal history. Be warned, this is not a cure and still requires diligence on your part or the system will fail. Fasting blood glucose values have been shown to be excellent – generally close to the pump set target range of 120 mg/dL.

MiniMed 670G

You can always choose to continue with injections and utilize one of two sensors. Dexcom (glucose readings every 5 minutes on a receiver or your cell phone) or the new Freestyle Libre that allows you to scan your sensor patch and see your glucose on a receiver.

And where is all of this going?

Oh – it is so exciting! I am confident that in the next five years a fully automated system will be available with minimal input from the user. Tandem, Omnipod and Medtronic are all working on fully integrated pumps as responsibly fast as they can. In addition, other options are coming too, including a dual hormone system that has reservoirs for insulin and glucagon to keep you safe. And with the new insulin from Novo Nordisk that is reputed to start absorption in 2.5 minutes (wow!) one of the big barriers to insulin delivery may have just been resolved.

Although a cure is what we are all hoping for, technology is the next best thing.

Embrace it and stay tuned!

Libre vs. Dexcom: A Diabetes Educator’s Experience

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Libre vs. Dexcom

When I heard the news that the Freestyle Libre was coming to the U.S., I was so excited, especially since it adds to the options for self-management technology for people with both type 1 and type 2 diabetes.

So, last week, I took advantage of the free Freestyle Libre reader and sensor offer for current Dexcom users.

I was so excited to try out the Libre and wear it with the Dexcom G5 to compare the two as a self-management experiment. I was prepared for the two devices to differ as one is a continuous glucose monitor (Dexcom) and the other is a flash glucose monitor (Libre). Here are my thoughts.

Ten Thoughts of a Certified Diabetes Educator

1. Filling the Prescription: Win for the Libre

I was able to get my hands on a Libre within 36 hours of claiming the offer. I contacted my endocrinologist to write me a prescription and almost immediately Walgreens worked on obtaining a Libre system for me. My Walgreens didn’t have the Libre in stock, so they placed an order, and I was able to pick it up the next day. Whenever I try to re-order Dexcom supplies through my third party distributor, it seems to be disastrous, and it takes a week or so to receive my shipment.

Considerations: If you do not have insurance coverage for a CGM, have a high deductible, or cannot afford your out-of-pocket cost with coinsurance, the Libre is a much more affordable option. However, make sure that your insurance will cover the Libre. If insurance covers the Dexcom (and you have good insurance coverage), but not the Libre, then Dexcom may be a more affordable option.

2. Insertion Process: Win for the Libre

The insertion instructions for the Libre are understandable and easy to follow which differs from the difficult Dexcom insertion process.

Considerations: If you are unfamiliar with diabetes technology, have low dexterity or have vision problems, the insertion process for the Libre may be much smoother than insertion of the Dexcom.

3. Sensor Life: Win for the Dexcom

The Libre sensor lasts ten days, and the Dexcom sensor lasts only seven days. However, many people have discovered how to trick the Dexcom sensor into continuing for much longer than seven days. The Libre is too smart to be fooled and requires a new sensor after ten days.

4. Sensor Start-Up: Win for the Dexcom

The Libre takes 12 hours to warm-up. I put it on before bed, but I still had to wait a few hours to use it when I woke up. I was anxious to get started! The two-hour start-up for the Dexcom isn’t so bad after all.

5. Calibration: Win for the Libre

The Libre is factory calibrated, so it does not need to be calibrated after warm up or throughout its ten-day session. The Dexcom requires two calibrations after its two-hour warm up and then one calibration every 12 hours.

At first, I thought this was an absolute win for the Libre. However, I noticed that there were a few instances where my Libre was significantly (60+ numbers off) from my meter reading and Dexcom reading. I understand that the Dexcom will be closer to the meter reading since it uses the meter reading for calibration but I felt scared that I couldn’t tell the Libre it was wrong to re-adjust it. I don’t think I’m fully ready to trust factory calibration yet.

Considerations: The factory calibration is a beautiful feature as it reduces user-burden. All the user has to do is insert the Libre before starting the session. This feature is beneficial for those who cannot or will not check their blood glucose manually throughout the day.

6. Graphs: Win for the Dexcom

The Libre gives a similar graph as the Dexcom. Both graphs showed comparable glucose variability patterns even if the numbers differed slightly. The Libre reader device reports and the Dexcom clarity reports have similar information.

The trend arrows are to be used similarly on both devices. However, my Dexcom seemed to be much more accurate with arrows when I was dropping. I self-manage based on my Dexcom trend arrows, so this was concerning to me.

One benefit of the Libre though is that it does not seem to lose signal like the Dexcom does, leaving lapses of glucose data in the graph.

Considerations: The Libre is still an excellent tool to look at average daily glucose patterns and make adjustments with your healthcare provider.

7. Accuracy: Win for the Dexcom

The Libre was significantly off from my Freestyle meter which is built into the Omnipod PDM, but the Dexcom matched up pretty closely due to calibration from the meter reading. However, since the FDA approved the G5 to dose off, I think it is safer to use the Dexcom reading for treatment decisions.

Considerations: My personal experience may differ from others. Additionally, research has found that the Libre’s mean average relative distance (MARD) is less than the Dexcom G4’s MARD—meaning that the Libre is more accurate than the Dexcom G4. There is limited research on the G5 MARD vs. the Libre though. If you just want a device to look at glucose trends and not to dose off of, there is no problem with the Libre (from my personal experience).

8. Reading Blood Glucose: Win for the Dexcom

The Libre requires that the user presses a button on the reader device to see their current blood glucose reading. Though I thought it would be annoying to carry around the reader device, it did not bother me!

dexcom integration

However, I do depend on looking at my blood glucose and trends throughout the day on my Apple Watch (through the Dexcom app) when I am at work, so having to pull out the device to check my blood glucose was much more apparent to my co-workers. The Libre doesn’t (currently) have any mobile apps with sharing features in the U.S. I also depend on the sharing feature for safety. Now that I have used a CGM with alerts and continuous glucose data for the past four years, missing continuous data makes me anxious.

Considerations: If you self-manage fine by checking your glucose a few times per day, the Libre may be less annoying and work very well for your needs.

9. Alarms: Win for the Dexcom

The Libre has no alarms like the Dexcom. I am not hypo-unaware (as of now), but I still worry about not waking up for a low blood sugar overnight. The alarms provide a safety net.

Considerations: If you are hypo-unaware or live alone, it may be safer to consider a device with alarms. Additionally, it appears there is a company (BluCon by Ambrosia) that does make an add-on device for the Libre so that you can receive alerts continuously and overnight for lows and on a mobile application.

10. Adhesive: Tie

I cleaned off my site area with alcohol before inserting the Libre. I was unsure of the guidelines for using skintac, so I did not use any before insertion.

After two days the Libre began to peel off, and I had to reinforce it with Tegaderm. The Dexcom also does not have great adhesive.

However, I have been using the Dexcom long enough to figure out the best way to make it stick for me (donut-shaped application of liquid skintac before insertion, gifgrips on after insertion, followed by additional liquid skintac on top).

Considerations: Both the Libre and the Dexcom seem to cause allergic reactions in some.

Final Thoughts

Trialing the Libre was an awesome opportunity as it gave me a sense of having patient choice for self-management tools.

However, I am not sure I am mentally ready to use the Libre over the Dexcom. I am used to using my Dexcom G5 CGM and have become somewhat dependent on its benefits for my peace of mind and sense of safety.

There are still many clear clinical benefits to using the Libre, however, and the best fit depends on individual self-management needs.

A 180-Day CGM: Senseonics’ Eversense XL Approved in Europe

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Eversense CGM for diabetes

 

Implanted sensor with on-body transmitter lasts more than 12x longer than other CGMs; launch expected in Europe in late 2017

Senseonics’ Eversense XL continuous glucose monitoring (CGM) system, featuring an implanted sensor with extended life of up to 180 days, has been approved in Europe. This decision doubles the previously-approved 90-day wear time, meaning that the sensor can be used more than 12 times longer than any other CGM sensor available in Europe.

Senseonics plans to launch Eversense XL in Europe later this year. In the US, the 90-day version remains under FDA review, with a possible approval later this year or in early 2018.

Like the 90-day Eversense CGM system, the 180-day Eversense XL features a small sensor (~5/8 inches long and ~1/8 inch in diameter; slightly larger than a pill) that is implanted in the upper arm. The 5-10 minute procedure can be carried out in a typical doctor’s office. It requires only local anesthesia and involves a small incision about one-quarter inch (5 to 8 mm) long. The user then wears a rechargeable transmitter device on the skin directly above the implanted sensor. The transmitter, which can be taken off and put back on at any time, powers the sensor and sends real-time glucose readings and trends to a smartphone.

Both the smartphone and on-body transmitter can alert the user of high or low glucose levels. When the phone is out of range, the on-body transmitter itself can provide a vibration alert – a cool feature that also distinguishes Eversense from other CGMs.

Eversense still requires two fingerstick calibrations per day and is not approved for insulin dosing or as a replacement for fingersticks (like Dexcom’s G5 or Abbott’s FreeStyle Libre).

Thus far, Senseonics has slowly rolled out Eversense in Europe, and we’ll be interested to see if the launch broadens and this new 180-day CGM option gains traction. Interestingly, approximately 80% of those who have gone on Eversense in Europe previously wore CGM.