Continuous glucose monitors are technological miracles that significantly improve care for people with diabetes. They can also be clunky, expensive, inconvenient to use.
One company has plans to change that, and make CGMs more popular by making them more cheaply, user-friendly, and reliable.
“It should be affordable, comfortable, scalable, and very easy to use,” says Michele Lussier, the CEO of Metronom Health, a private company based in Belgium and the United States that is working to make a better CGM. “It should prompt you to recalibrate it, for instance. It should have a soft sensor and should be a soft, flexible device.”
That’s a lot of “it should’s” and it’s probably the right way to look at improving CGMs so that their use becomes more common by both people with type 1 and type 2 diabetes. There does not appear to be a single, magic bullet improvement to the design and concept of existing CGMs that will make them more accepted, and more popular, as a tool for improving care. Instead, several areas need to be addressed to get them in the hands of more people.
The market potential for CGMs is enormous because so few people with diabetes are now using them. Lussier estimates that only about 10 percent of people with type 1 use a CGM, and the numbers are less for type 2s. While there is no hard data to pinpoint exactly how many people with diabetes are (or are not) using CGMs, several studies concur that the number is very low compared to the how many could benefit from their use.
A joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group in December 2017 found that fifteen years after they were first introduced, “the proportion of individuals using CGM rather than conventional systems for self-monitoring of blood glucose on a daily basis is still low in most parts of the world.” Issues contributing to this phenomenon include the need to calibrate CGMs once or more times daily; high costs; the need to replace on-body sensors on a frequent basis; poor adhesive capability to keep the sensor attached to the skin; the burden of simply having to wear a device; the lack of insurance coverage (which is almost universal for the large number of type 2s who could improve their care by using a CGM); and the lack of reliability and accuracy of some CGMs.
Another study by T1D Exchange in April 2016 generated some more specific reasons to why people do not use CGMs. Topping the list, 71 percent cited “Problems with the CGM working properly/not accurate enough,” and 61 percent of those studied said they stopped using the device because of “Problems with the sensor insertion/adhesive.”
“Plus,” Lussier says, “At a time when technology is getting more and more user friendly—just look at phones—CGMs are just not designed very well. They are unattractive, and difficult to use.”
Metronom, which was founded in 2010, is tackling improvements on several fronts, according to company cofounder and Chief Scientific Officer, Troy Bremer.
The first area is improving the technology underlying how glucose is detected and measured by combining four sensors into one package to separately read high, normal and low blood sugar levels.
Like other CGMs, Metronom’s CGM contains an enzyme that senses a person’s glucose and, in reaction to that level, produces hydrogen peroxide. Unlike other commercially available CGMs, a second enzyme then changes the peroxide into oxygen and water. The device senses this remaining oxygen to then produce a glucose reading. The added sensing capability of Metronom’s CGM is the ability to sense oxygen directly in separate locations to measure low, medium and high glucose levels compared to an oxygen reference. This theoretically means it’s more accurate because, often in other CGMs, compression of the actual sensor can be read as a drop in glucose levels, which can’t happen in Metronom’s sensor, Bremer says.
“I came up with the idea while I was stuck in traffic in San Diego,” adds Bremer, whose wife has diabetes and who has dedicated years of his life to designing a better CGM.
Additionally, Metronom’s CGM uses opto-enzymatic detection of glucose that measures the oxygen, produces light, and measures the decay of that light to produce a glucose level read out. This is radically different than other CGMs that use electrochemical sensors, which can be more prone to faulty readings, Bremer says.
Metronom is also using a proprietary adhesive that, according to Bremer, “does not get wet” and does not peel. He also says the system—which uses a phone or watch as a receiver to provide data readout—will let the user know when it needs to be calibrated, making it easier to use, with less interaction than existing sensors.
Affordability and CGM access are areas of focus for Metronom. The device will be built with outsourced components where possible to reduce cost. Bremer says he knows insurance coverage for CGMs is a complicated issue, but also mentions that when the Libre CGM first came out “people were fighting to get it regardless of coverage. So, the market is there.”
He adds that the cost of Metronom’s CGM will be between $4 and $5 per day. He expects it to be released in Europe perhaps as early as 2020
“If you’re able to afford a Starbucks before work, you’ll be able to afford this sensor,” he says.
That price point, Lussier says, should help open the CGM market to peope with type 2 diabetes.
“We are looking to make an easier to use, friendlier and more efficient CGM because if more people use it more people will benefit from it,” Bremer says. “It’s really that simple.”