U.S. Food & Drug Administration (FDA).

CBD for Type 2 Diabetes: What Are the Benefits and Risks?

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You probably don’t have to look further than your local drugstore or beauty product supplier to know CBD has taken a starring role in everything from sparkling water and gummies to tincture oils and lotions. Some may even say that cannabidiol (CBD) — which, like THC, is a component of the cannabis plant, but doesn’t contain its psychoactive effects — is the “it” ingredient of our age.

You’ve probably also heard that CBD can help lessen stress, anxiety, and pain. “When people are in pain, they have a stress response, which causes an increase in cortisol and an increase in blood sugar,” says Veronica J. Brady, PhD, CDCES, a registered nurse and an assistant professor at the Cizik School of Nursing at the University of Texas in Houston. Relieving pain can help alleviate the stress response and improve blood sugar levels, as well as aid sleep, she says.

If you’re managing type 2 diabetes, it’s natural to be curious about whether CBD might help you manage those symptoms, too, to help stabilize your blood sugar. In fact, the prevalence of cannabis use increased by 340 percent among people with diabetes from 2005 to 2018, according to one study, which surveyed people on their use of cannabis (CBD or THC, in any form) in the previous 30 days.

But will popping some CBD gummies for diabetes work  Some healthcare professionals say CBD may have a role to play, but it’s important to understand that the only health condition CBD has proved effective for is epilepsy in kids. The jury is unfortunately still out, owing to the lack of comprehensive research on CBD for diabetes.

Still, in the aforementioned survey, 78 percent of people used cannabis that was not prescribed by a doctor. “Diabetes patients might still use cannabis for medical reasons, but not have a prescription,” says Omayma Alshaarawy, MBBS, PhD, an assistant professor in the department of family medicine at Michigan State University in East Lansing, who led the study. Recreational use is another factor. She points to a separate study that found that more than 50 percent of people with medical conditions such as diabetes or cancer use cannabis recreationally.

How People With Type 2 Diabetes Are Using CBD

In Nevada, where Dr. Brady used to work as a certified diabetes educator, her patients with type 2 diabetes used CBD for nerve pain. She says patients would use CBD in a tincture or in oils that they rubbed on painful areas, including their feet. Patients could buy CBD at medical marijuana dispensaries, which would offer dosing instructions. “They worried about the impact on their blood sugars,” says Brady.

Ultimately, though, Brady says that her patients reported that CBD reduced their nerve pain and improved their blood sugar. She adds that those people who used CBD oils for nerve pain also reported sleeping better.

Heather Jackson, the founder and board president of Realm of Caring in Colorado Springs, Colorado, a nonprofit that focuses on cannabis research and education, senses a community interest in CBD for diabetes. “In general, especially if they’re not well controlled, people are looking at cannabinoid therapy as an alternative, and usually as an adjunct option,” says Jackson. Callers have questions about CBD for neuropathy pain, joint pain, gastrointestinal issues, and occasionally blood glucose control, according to a spokesperson for Realm of Caring.

The organization receives thousands of inquiries about cannabis therapies a month. It keeps a registry of these callers, where they live, and their health conditions. Jackson says that people with type 2 diabetes are not a large percentage of the callers, but they currently have 540 people with diabetes in their database.

Jackson says that Realm of Caring does not offer medical advice, and it does not grow or sell cannabis. Instead, it offers education for clients and doctors about cannabis, based on its ever-growing registry of CBD users, their conditions, side effects, and administration regimen. “We are basically educating,” says Jackson. “We want you to talk to your doctor about the information you receive.”

Scientific Studies on CBD and Type 2 Diabetes and Barriers to Research

Despite interest among people with type 2 diabetes, large, rigorous studies showing how CBD may affect type 2 diabetes are lacking, says Y. Tony Yang, MPH, a doctor of science in health policy and management and a professor at George Washington University School of Nursing in Washington, DC. Specifically absent are randomized controlled trials, which are the gold standard of medical research.

At the very least, a case report from 2021 suggests that CBD is unlikely to cause harm or worsen diabetes control. (The American Diabetes Association also stresses that CBD should not be considered a replacement for traditional diabetes management.)

Other research suggests the use of CBD for diabetes is indeed worth further study. For example, a small study in the United Kingdom looked at 62 people with type 2 diabetes and found that CBD did not lower blood glucose. Participants were not on insulin, but some took other diabetes drugs. They were randomly assigned to five different treatment groups for 13 weeks: 100 milligrams (mg) of CBD twice daily; 5 mg of THCV (another chemical in cannabis) twice daily; 5 mg CBD and 5 mg THCV together twice daily; 100 mg CBD and 5 mg of THCV together twice daily; or placebo. In their paper, the authors reported that THCV (but not CBD) significantly improved blood glucose control.

Other CBD research is still evolving. Some research on CBD for diabetes has been done in rats, which leads to findings that don’t always apply to human health. Other research has looked more generally at the body’s endocannabinoid system, which sends signals about pain, stress, sleep, and other important functions. Still other studies have looked at marijuana and diabetes, but not CBD specifically.

That there are so few studies of CBD in people with type 2 diabetes has to do with a lack of focus on CBD as an individual component. Historically, cannabinoids (a group of chemicals in the cannabis plant) have been lumped together, including CBD, THC, and more than 100 others. The 1970 U.S. Controlled Substances Act classifies cannabis as a Schedule 1 drug with the highest restrictions, according to the Alcohol Policy Information System. Currently, 38 states allow cannabis for medical use, and 24 states and the District of Columbia have passed legislation allowing cannabis for recreational use, per CNN.

The 2018 Farm Bill removed industrial hemp from the controlled substances list, clearing the way for more production and research of CBD. Meanwhile, growers and manufacturers are better able to isolate CBD, mainly by cultivating industrial hemp that is high in CBD and very low in THC, says Jackson. So, perhaps in the coming years, more research on CBD and diabetes will emerge.

How the FDA Views and Regulates CBD for Disease Treatment

Yet, as evidenced by a previously cited study, people with type 2 diabetes aren’t waiting for further study to hop on the trend. Brady says her patients have been open about using CBD, particularly the younger patients. She says one of her older patients was initially uncomfortable about buying CBD in the same shop that sold marijuana but eventually gave in. Brady adds that many people associate CBD with smoking marijuana, despite their distinctly different effects on the body.

The U.S. Food and Drug Administration (FDA) approved the first CBD medication in 2018, for treating childhood epilepsy. Currently, there is no other FDA-approved CBD medication for diabetes or any other condition, according to the FDA. In December 2018, the FDA said it was unlawful under the Federal Food, Drug, and Cosmetic Act to sell food or dietary supplements containing CBD. But in January 2023 the FDA concluded that a new regulatory pathway for CBD is necessary and that it intends to work with Congress to develop one.

“The FDA, for the time being, has focused its limited enforcement resources on removing CBD products that make claims of curing or treating disease, leaving many CBD products for sale,” wrote Pieter Cohen, MD, and Joshua Sharfstein, MD, in The New England Journal of Medicine. Dr. Cohen is an assistant professor of medicine at Harvard Medical School in Boston, and Dr. Sharfstein is the vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Precautions for People With Diabetes Looking to Try CBD

For the CBD products already on the market, Jackson says it’s often difficult to know what’s inside. One study found that only 30 percent of CBD products were accurately labeled, with under- and over-labeling of CBD content, and some products containing unlisted chemicals such as THC.

Vaping liquids were the most commonly mislabeled CBD products in the study. The Centers for Disease Control and Prevention (CDC) warns that consumers should not purchase any vape products from unregulated and illicit markets or attempt to modify vape products outside of how the manufacturer intended. The Associated Press has shown that some CBD vapes have synthetic marijuana.

Jackson points out that CBD may affect certain cholesterol and blood pressure drugs, and research has detailed these interactions. Other side effects of CBD include tiredness, diarrhea, and changes in weight or appetite, the researchers write.

“What you put in your body is really important,” says Jackson, adding that’s especially true for people with major health conditions like diabetes. Jackson speaks from personal experience as a mom finding CBD treatments for her son’s epilepsy. She says consumers should ask manufacturers whether CBD products are free of mold, pesticides, and other toxins.

Realm of Caring, Jackson’s nonprofit, created a reference sheet for evaluating products and manufacturers. It also endorses products that adhere to standards such as those from the American Herbal Products Association and the FDA’s Current Good Manufacturing Practice regulations.

“There is little known about cannabis health effects, especially among patients with chronic conditions. Research is growing, but still solid evidence evolves,” says Dr. Alshaarawy. For these reasons, she recommends that patients talk to their doctors so they can discuss the benefits and potential harms of cannabis and monitor their health accordingly.

How to Talk to Your Healthcare Provider About Using CBD for Type 2 Diabetes

Jackson and Brady advise people who are considering CBD for diabetes to ask their providers about the complementary therapy before adding it to their treatment plan. Brady says it’s difficult to find research about CBD and type 2 diabetes, even in her capacity as a diabetes educator. Still, in her experience, if people are looking for a natural way to manage pain, it’s worth a conversation with their healthcare provider. “It’s something that should be talked about, especially if they’re having significant amounts of pain, or really any pain at all associated with their diabetes,” says Brady.

“It’s a reasonable alternative,” says Brady. “As it gains in popularity, there needs to be some information out there about it.

New Research Proves the Pancreas Can Regenerate

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Beta cell regeneration – progenitor cells (green) can become insulin-producing cells (red) [courtesy of the Diabetes Research Institute]

Type 1 diabetes is caused by an autoimmune attack that destroys the beta cells, the part of the body that produces the essential hormone insulin. It is generally supposed that once these cells have been lost, they are gone forever. In the search for a cure, the most advanced research has concentrated on the transplantation of new beta cells — either from an organ donor or grown in a laboratory — to replace the cells that have been irrevocably lost.

But what if your body could be directed to regrow its own new beta cells? A lead investigator at the Diabetes Research Institute believes that the pancreas can regenerate beta cells, and that his lab has discovered how to make it happen.

A Century of Questions

Many human cells can regenerate themselves. You may have heard that, due to constant cell regrowth, the entire human body is replaced every seven years. That’s not quite right — while most of your skin cells turn over within months, you also have brain cells that never have been and never will be replaced.

The pancreas, like most other internal organs, is slow to regenerate and has a very limited ability to heal itself. But doctors have long suspected that the pancreas harbors the ability to regenerate the islet cells, which contain the insulin-producing beta cells. “The concept has been around for more than 100 years,” since even before the discovery of insulin, says Juan Dominguez-Bendala, PhD. It’s always been a controversial idea, but he believes that the debate has now been settled.

Dr. Dominguez-Bendala is the Director of Stem Cell & Pancreatic Regeneration and Research at the Diabetes Research Institute. His team, in a collaborative effort with his colleague Dr. Ricardo Pastori, recently published a report in Cell Metabolism that finally proves that the adult human body is capable of growing new beta cells:

“I think that this is very definitive. We’re looking at regeneration in the real thing, the real human pancreas. We see this happening in real-time. It’s unequivocal.”

New Evidence

The islet cells that contain both the beta cells and other important exocrine cells only make up a small minority of the pancreas’ mass. Most of the organ is devoted to a ductal system that helps synthesize digestive juices and transport them to the intestines. In the embryo, though, this part of the pancreas also creates the islet cells.

“There are lots of people that don’t believe that this is a process that happens during normal adult life. But what we and others contend is that when there’s extensive damage to the pancreas, there’s a partial reactivation of the embryonic program that brought about islet cells in the first place. There are stem cells in the ducts that give rise to new islets.”

For years, however, the evidence in favor of human islet regeneration only came in the form of samples from the pancreases of deceased people. It had never been possible to observe the regeneration of islet cells in real-time, and “the evidence was rather circumstantial.” There was supporting evidence from mouse models, but Dominguez-Bendala admits that this was of limited value: “We have cured diabetes in mice hundreds of different ways, and none of them have ever worked in humans.”

Scientists received a new tool with the establishment of nPOD, the Network for Pancreatic Organ Donors with Diabetes. Founded and supported by the leading charity JDRF, nPOD encourages people with diabetes to sign up as organ donors and donate their pancreases to science. This national network is the only way for American researchers to receive a reliable supply of viable organs from people with type 1 diabetes.

Dominguez-Bendala’s lab began receiving donations of pancreas slices in 2018. It took some tinkering, but they found a medium that “could extend the life and functionality in vitro for about two weeks, which was plenty for us to start seeing if there’s regeneration.” It provided, for the first time, “a window into the real pancreas.”

How to Stimulate Beta Cell Regeneration

If pancreatic regeneration does occur naturally, it’s obviously not enough to substantially heal people with diabetes or pancreatitis. To make a difference, Dominguez-Bendala would have to find a way to accelerate and amplify the regeneration process. His secret ingredient may be a natural human growth factor named BMP7.

BMP7 is “like a fuel for stem cells across the body,” and Dominguez-Bendala wanted to see if it could have the same effect in the pancreas. The substance is well-studied and is already approved for an unrelated condition: “It’s already in clinical use. It regrows bone, and is used to fuse vertebrae when you have spinal surgery.”

The team at Dominguez-Bendala’s lab would take multiple pancreatic slices from a single donor and treated some with BMP7. When they took a closer look, they saw exactly what they had hoped: new hybrid cells emerging from the ductal mass of the pancreas and creating a bridge towards the area where islet cells are born. A trajectory analysis showed that some of the new hybrid cells “became new islet cells.”

“We showed for the first time, in a human-based model, how regeneration works.”

“We discovered that progenitor cells inside the ducts respond to BMP7 by proliferating, and then when you remove the BMP7, they differentiate into all the different cell types of the pancreas.”

“To me, it doesn’t get any more promising than that,” Dominguez-Bendala said. “You can cure diabetes left and right in mice, but to show that you can induce beta cell regeneration in a type 1 diabetes donor? That’s something really major.”

Next, they had to prove that the new islet cells were actually functional. Could they respond to high blood sugar levels, secrete insulin, and correct hyperglycemia? “When we look at the neogenic cells, the cells that have been formed as a result of BMP7 stimulation, we can see that they respond to glucose stimulation by making insulin.”

It will take several years and “a lot of boring experiments” to convince the FDA that the therapy is safe to try in humans. Studies of mice, at least, show that BMP7 causes no other dysfunctional tissue growth. It also doesn’t stimulate islet cell growth in healthy mice, suggesting that the substance naturally targets injuries: “We think it takes an extreme degree of damage to the pancreas for this very primitive regeneration program to be activated.” Studies in humans help show that BMP7 is safe for general use, including when used to help heal kidney disease.

The Immunity Problem

Beta cell regeneration has the same big problem that every other proposed type 1 diabetes cure has: the immune system. Transplanted islet cells — whether they come from an organ donor or a laboratory manufacturing process — can correct hyperglycemia and grant insulin independence, but thus far nobody has figured out how to protect them from the immune system without the use of powerful drugs (with potentially powerful side effects).

“This doesn’t work unless we do something about the immune system, or else the new cells will be destroyed again and again,” says Dominguez-Bendala. “We envision this as a combination therapy alongside immunotherapies.”

Dominguez-Bendala is gambling, along with the rest of the diabetes world, that better immunotherapies are coming soon. In the meanwhile, the first patient population likely to benefit from any beta cell regeneration therapy are people who have received a kidney transplant, patients who therefore already require anti-rejection medications.

There is at least some hope, however, that naturally regenerated beta cells will be easier to protect from the immune system than transplanted cells, which the body’s defenses identify as foreign. We won’t know yet how the body will respond to neogenic cells: “The truth is that we don’t know. I have spoken to immunologists who believe that the new cells may be able to sneak in and won’t be destroyed as quickly as the ones that were destroyed in the first place. I’m hopeful that it will happen, but I’m not counting on that.”

Timeline

Beta cell regeneration is in its infancy as a therapy, and will require many years of experimentation before it gets anywhere close to FDA approval. I asked Dominguez-Bendala if a more advanced potential cure — such as Vertex’s VX-264 — might succeed first and render his work obsolete. Dominguez-Bendala doesn’t see Vertex as a competitor — his lab has helped contribute to progress in the field of stem cell differentiation — but he is emphatic that VX-264 will not be a full cure and will not end the search for better type 1 diabetes remedies:

“It’s not a cure by any stretch of the imagination. It’s a brute force strategy, putting things in the body, and the body is attacking them. What we are proposing is fundamentally different, to harness the very natural ability of the pancreas to heal itself. That’s a much more holistic approach.”

Several other research groups are investigating parallel therapies. In France, a startup named DiogenX believes it has found another way to regenerate the beta cells. And just last week, an Australian team published a study of another method that could stimulate beta cell regeneration.

“I’m hopeful that it will be available sooner rather than later. We could spend twenty years exploring the little details of the mechanisms, but that’s not what the Diabetes Research Institute is about. We want to have therapies in the clinic as soon as possible. That’s our mission, and that’s what we are going to do.”

Exenatide via Osmotic Mini-Pump Improved A1c and Weight

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ITCA 650 by Intarcia

 

ITCA 650 is exenatide in an osmotic mini-pump, a type 2 diabetes medication. It continually provides subcutaneous medication for 3 to 6 months.

Currently, exenatide is available as the brand name Byetta which is a liquid injection and also an extended release formulation marketed as Bydureon which comes in a powder that is mixed with liquid and then injected.

Researchers tested out ITCA 650 in two dose amounts and compared it to a placebo in patients with uncontrolled type 2 diabetes.

Over 39 weeks, this phase 3, double-blind, placebo-controlled trial randomized 460 patients between the ages of 18 and 80 who had an A1c level between 7.5 and 10 % (58-86 mmol/mol). So a third of participants took a placebo, another third ITCA 650 40 μg per day and another third took ITCA 650 60 μg per day.

The researchers looked for any A1c changes after those 39 weeks.

Does Exenatide Help Lower A1c Levels?

Taking ITCA 650 showed to lower A1c levels when compared to the placebo dose. The researchers wrote in their abstract that “In a prespecified analysis, greater HbA1creductions occurred in patients not receiving sulfonylureas (SUs) vs. those receiving SUs (−1.7% vs. −1.2% [−18.6 and −13.1 mmol/mol].”

They add that on week 39 37% of those taking ITCA 650 40 μg per day had an A1c below 7% (53 mmol/mol)–44% of those taking 60 μg per day lowered their A1c under 7% (53 mmol/mol) and only 9% of the placebo group lowered their A1c under 7% (53 mmol/mol).

ITCA 650 users also showed more weight loss than those on the placebo. The higher the dose of ITCA 650, the more weight lost.

As far as the most common adverse event, nausea was observed but also showed to go away with time. Of those taking ITCA, 7.2% stopped taking the medication because of gastrointestinal adverse effects while only 1.3% of patients stopped taking the placebo due to the same.

They concluded that “ITCA 650 significantly reduced HbA1c and weight compared with placebo and was well tolerated in patients with uncontrolled type 2 diabetes on oral antidiabetes medications.”

Wait, How Does an Osmotic Mini-Pump Work?

Intarcia Therapeutics is the company behind the osmotic mini-pump for ITCA 650. Their website states that their Medici Drug Delivery System is made so a trained healthcare provider can insert it in a patient during a regular in-office visit.

First it is placed under the skin and then “water from the extracellular fluid enters the pump device at one end – by diffusing through a semi-permeable membrane directly into an osmotic engine – that expands to drive a piston at a controlled rate.” This action lets the drug inside the pump release continuously at the other end of the pump. These osmotic mini-pumps are created to carry “an appropriate volume of drug over different dosing intervals,” states the company’s website.

The company is currently awaiting FDA approval.

Regarding the insertion of this device, the study authors state that the adverse effects “associated with procedures to place and remove ITCA 650 were mild and transient”.

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.