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Continuous Glucose Monitoring (CGM) System
If you’re looking for a continuous glucose monitoring system to add to your diabetes toolbox, it may be daunting to figure out which system best fits your needs and priorities. We break it down for you here, with an overview of the Dexcom G6 CGM System, and its key benefits.
The Dexcom G6 system is made up of three components:
- Sensor – measures glucose levels just underneath the skin
- Transmitter – fastened on top of the sensor, it sends data wirelessly to a compatible smart device or an optional receiver
- Display Device – can be any compatible smart device with the Dexcom G6 app, or an optional Dexcom receiver
More on CGM system components:What is a Continuous Glucose Monitor?
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Top 6 Benefits of Dexcom G6
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1. No More Fingersticks!
With G6, we no longer have to complete an independent BG meter check to calibrate the sensor or to make treatment decisions (should I take a low treatment? should I give insulin to correct a high? how much?). (Unless, the company reminds us, our glucose alerts and readings from the G6 do not match symptoms or expectations, in which case it’s wise to use a blood glucose meter to make treatment decisions.)
The flip-side of not having to provide corroborating glucose information is that there is, in fact, no way to provide such info; we cannot calibrate the system with a number from a BG meter. How this works out in terms of the validity of the readings, well, I’m not sure yet. The system is already available in other countries, and the reports I’ve read are that the real-life accuracy of the G6 is comparable to the previous G5 system. However, my 12 year old son has a fair bit of site irritation and inflammation with all CGM systems, so we’ll have to see how the G6 works out for him and others who have the same sort of skin reactions.
2. Re-designed Sensor & Inserter
Dexcom G6 sensors now last 10 days (3 days longer than G5 sensors, which were changed every 7 days).
The new G6 sensor is also slimmer and flatter than the G5, making it more discrete.
The sensors are also now easier to insert, with the re-designed one-click inserter. Since the insertion needle is now “hidden” within the plastic casing, you don’t see the needle. Most importantly, your kids don’t see the needle, making the whole insertion process less intimidating.
3. Glucose Readings at a Glance
Continuous glucose readings are sent automatically via Bluetooth to any compatible smart device, or to a Dexcom receiver, at five-minute intervals. This means your child doesn’t have to scan to check her glucose, she can just glance at the display device.
In addition to being able to view glucose values on a phone, you can also view them in real-time on a smartwatch.
In this example, the 8.0 mmol/L near the top left is the current glucose level, while the diagonal-down arrow shows the glucose trend (glucose is falling slowly).
(Note that the transmitter does not communicate with the watch directly – a phone or smart device is still required.)
4. Remote Monitoring in Real Time
Not only can your child see their glucose readings at a glance – so can you. Even when you’re not with them.
With the Dexcom G6 app, the CGM user can share their blood glucose levels with up to 5 Followers (Following requires the Dexcom Follow App and an Internet connection). This means that loved ones can remotely view the CGM user’s glucose data in real time. Parents can see their child’s glucose reading and trends even when their child is at school, out on the soccer field, or sleeping over at a friend’s house.
How does remote monitoring improve real life with type 1?
- No more “what’s your number?” ambushes. Now, when your child gets home from school, you can focus on what their day was like and what they learned instead of immediately asking them to check their blood sugars.
- Parents can say “yes” to sleepovers. Since you can see what’s happening with your child’s glucose readings and trends, even from blocks (or many kilometres!) away, you can check in without having to be there next to your child; you can intervene if needed, and back off to give your child independence if all’s well.
- Parents can get some sleep! You don’t need to get up to go to your child’s room to prick their finger to get a glucose number. One glance at your smartphone can tell you their glucose level and the direction it’s heading. Or, since you receive an alert on your smartphone if glucose falls below the low threshold that you set, you can choose to sleep through the night.
How does Remote Monitoring Work?
There are 2 sides to the remote-glucose-viewing equation:
- the person with diabetes wears the sensor/transmitter; the transmitter communicates via Bluetooth with the CGM-user’s phone or smart device using the Dexcom G6 app. With the Share feature of the Dexcom app, the user gives up to 5 people permission to follow the data;
- In order to follow, the parent installs the Dexcom Follow app onto their own phone / smart device, and must have an Internet connection to access the data.
(The Dexcom G6 and Dexcom Follow apps are available for both iOS and Android – see www.dexcom.com/compatibility for the list of compatible devices)
5. Glucose Alerts
CGM measures your glucose levels continuously, even when you’re not attending to it – so it can notify you of highs and lows (even those that you may have missed) based on alerts that you set.
The Dexcom G6 still includes the tried and true alerts from G5 and previous systems, such as:
PLUS the Dexcom G6 now also includes a new alert:
You can choose which alerts you want turned on or off, and can change & customize them at any time. There’s also more flexibility with G6 alerts: you can set different alert levels for the night-time vs. the day.
For extra safety, the Dexcom CGM System includes a fixed hypo alarm which cannot be adjusted or turned off:
How can alerts improve real life with type 1?
- Alerts can help catch lows before they happen. This is particularly important for anyone who doesn’t feel their lows (hypo unaware), and especially for parents of young children who may not reliably detect their lows or be able to communicate lows to parents.
- The Rate of Change Alerts give you a heads-up when blood sugars are changing quickly, which is particularly important if blood sugars are crashing. The same is true of highs: there is also a Rate of Change Alert for rapidly increasing glucose levels, which gives you the opportunity to get a dose of correction insulin in earlier, if you choose.
- Parents can receive high and low glucose alerts on their mobile device, and can program the alert levels and tones as appropriate; each person can choose how and when they would like to receive alerts. For example, the child’s smart device/receiver may have the low alert set to 4.0 mmol/L, while the parent’s low alert could be set to 5.0 mmol/L, to give more advance warning of a low.
6. You don’t have to Pump Your Insulin to use CGM
Like the previous incarnation (Dexcom G5 Mobile), the G6 is a stand-alone system. You don’t need to be on an insulin pump to use it; individuals on injections can also use this CGM system to reduce fingerpokes, to catch undetected glucose extremes, and to gather information about patterns and trends.
A study (6) in the early days of CGM use showed that CGM provides similar benefits in glucose control for both patients on MDI and those on insulin pump therapy: less time was spent in both hypoglycemic and hyperglycemic ranges. In addition, a 2018 randomised controlled trial (7) demonstrated that using real-time continuous glucose monitoring reduced the number of hypoglycemic events (lows) in individuals with type 1 diabetes treated by MDI and with impaired hypoglycemia awareness or severe hypoglycemia: the average number of hypoglycemic events (per 28 days) among participants in the real-time continuous glucose monitoring group was reduced from 10.8 to 3.5, while reductions among control participants (without CGM) were negligible. (Both studies received funding from Dexcom, Inc.)
The Dexcom G4 Platinum System (previous generation Dexcom) was shown in independent research studies to have the best-in-class sensor accuracy (1,2,3) of any CGM system available in Canada. But just how accurate is it? To illustrate, two research studies on the clinical accuracy of earlier generation Dexcom systems showed that overall average glucose sensor values (measured as mean absolute relative difference, or MARD), when compared to lab analyzer blood glucose values (using a blood sample taken from a vein) were within 10% for children (4), and 9% for adults (5). It follows logically that tech advancements have made the Dexcom G6 CGM System at least as, or more, accurate.
Further, Dexcom is the only CGM system approved to replace fingerstick testing for treatment decisions – in any blood glucose range. That means that when the G6 reads your glucose as low, you don’t need to confirm that reading with a fingerstick check before treating the low with fast-acting glucose. It also means that when the G6 reads your glucose as being above your target range (high glucose), you don’t need to confirm that with a fingerstick check before dosing insulin to correct the high.
Finally, the G6 sensor is not affected by acetaminophen use. So if you give your child Tylenol® for aches, pains or a fever, you don’t have to go back to fingersticks.
How does accuracy impact life with Type 1?
Accuracy is critical when it comes to trusting any continuous glucose monitoring system and its utility in real life. An accurate system is one you can trust. Only if you trust the displayed glucose value can you skip the fingerstick check, saving you time and hassle.
What else should I know about Dexcom?
ǂ G6 readings can be used to make diabetes treatment decisions when taking up to a maximum acetaminophen dose of 1,000mg every six hours. Taking a higher dose may affect the G6 readings.
1. Damiano E, et al. A Comparative effectiveness analysis of three continuous glucose monitors: the Navigator, G4 Platinum, and Enlite. J Diabetes Sci Technol 2014; 8(4):699-708.
2. Matuleviciene V, et al. A clinical trial of the accuracy and treatment experience of the Dexcom G4 sensor (Dexcom G4 System) and Enlite sensor (Guardian REAL-Time System) tested simultaneously in ambulatory patients with type 1 diabetes. Diabetes Technol Ther 2014; 16(11):1-9.
3. Kropff J, et al. Accuracy of two continuous glucose monitoring systems: a head-to-head comparison under clinical research center and daily life conditions. Diabet Obes Metab 2014. Doi: 10.1111dom.12378, Epub 10 Sept 14.
4. Laffel. Improved Accuracy of Continuous Glucose Monitoring Systems in Pediatric Patients with Diabetes Mellitus – Results from Two Studies. Diabetes Technol Ther 2016; 18 (Supp 2).
5. Bailey, Chang, Christiansen. Clinical Accuracy of a Continuous Glucose Monitoring System with an Advanced Algorithm. J Diabetes Sc Tech 2015; 9(2): 209-214.
6. Garg SK, Voelmle MK, Beatson CR, et al. Use of Continuous Glucose Monitoring in Subjects With Type 1 Diabetes on Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion Therapy: A prospective 6-month study. Diabetes Care. 2011; 34(3):574-579. doi:10.2337/dc10-1852.
7. Heinemann, Lutz et al. Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. The Lancet, 2018; 391(10128): 1367 – 1377.
The above information was reviewed for content accuracy by a representative of Dexcom Canada.
This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.
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