SARAH: Welcome back to the Southeast Ohio Qi Hub video series. I hope that you enjoyed our last series with our special guest that we had from the last newsletter. But today I would like to welcome back our favorite diabetologist, Dr. Amber Healy. For the last several months we have been talking about updates to CGMs 'cause things have changed and are changing. Um, so we invite invited Dr. Healy Beck. We're gonna do this little recording to some updates for the CGMs. Hi Dr. Healy. 

AMBER: Hi. You know what? It's easy to be the favorite Diabetologist when you're the only one. 

SARAH: No one has to know that. Talk to me. Talk to me. Give me some updates to CGMs. I don't know where you wanna start. 'cause we've talked about a few things. Um, but I know things are changing. 

AMBER: I think the first is what's not gonna be available. Um, in the near future. So the Libre 2. Libre 3.  And the Guardian Connect.  And so, um, people are going 2 and 3, I still see 2 and 3. But it's actually the 2+ and the 3+ that you're gonna see that are gonna continue to be made and exist for use. 

SARAH: Okay. And that's, so the Freestyle 2 and 3 are being discontinued and they're changing to the 2+. So what's the difference in those? 

AMBER: So 2+ and 3+ are both 15 day wear. And then they actually integrate with insulin pumps. Those are the two big things that I see when I, you know, when I talk with patients about them. There might be some other nuances that I am not aware of, but... 

SARAH: So an additional day instead of the 14, it lasts 15. 

AMBER: Right.

SARAH: And integration with insulin pumps. Fantastic. So that was the Freestyle Libre.

AMBER: Right. 

SARAH: Awesome. What's, what else? 

AMBER: So, uh, Dexcom G6 and G7, they will continue to exist. Uh, they're still both 10 day wears. Integrated with insulin pumps, still able to calibrate them all the things. Um, but, uh, they are actually gonna be releasing a Dexcom G7 15 day wear. Um, so the, you're like, okay, so why, why would we keep the Dexcom G7 around and the Dexcom G7 15 day wear? Well, the difference is age indication of use. So the 15 day wear will only be approved for 18 and up. And so keeping the, the regular 7, it's still approved for pediatrics age two and Up. 

SARAH: Okay. Excellent. Alright. That's good to know. That's important. Thank you. 

AMBER: Absolutely. 

SARAH: Anything else? Any other changes? Discontinuations of any of the CGMs? 

AMBER: No, no other discontinued but another, I mean I mentioned the Guardian connect. Which is Medtronic's. Uh, sensor. But Medtronic is gonna be going to their Simplera system. And those will be integrated with their pumps. Uh, previous it was the Guardian 4. For them. But they will also be integrated with the smart pens out there. Like the InPen. The other sensor we haven't really talked about, it's not new.  Uh, but it's, it's been around in different forms. Is the ever since 365. Which is an implantable sensor.  So it's implanted a lot like an Implanon on into the arm. It's indicated for ages 18 and up. Uh, it can stay in for the whole year. 

SARAH: Wow. 

AMBER: But you have to wear a transmitter on the outside. And it has to be charged regularly. It has a 24 hour warmup period. And then there's a calibration schedule that has to be followed, uh, at throughout the beginning of its placement. So there'll still be some finger sticks. It is integrated with one insulin pump at this point that is not quite widely available. But is coming, uh, it's called the Sequel. Twiist pump. Sequel's the company. And Twiist is the pump two i's in Twiist actually. Um, but it's interesting because this sensor, it's not necessarily new because when it first came out it was good for like 30 days and then there was like a 90 day version and then 180 day version. Now we've gotten out to the year. Uh, so that sensor has to be replaced on a yearly basis now. 


SARAH: Okay. But there are pros and cons. There's still some finger sticks that need to happen at the beginning. It doesn't integrate with the pumps. So we're still in that phase where we might not see it a lot. 

AMBER: you're not gonna see it a lot. There are gonna be, there are some people that like it because it's a little more discreet too. Because it doesn't alarm. It has different vibration patterns that's that alert someone to their sugar going high or low. 

SARAH: Okay. Alright. That's and type one or type two, I'm guessing, uh, 

AMBER: You're gonna see this more with type one. Type One. 

SARAH: That's what I was guessing. Okay. That sounds good. Alright. Thank you for that. That's really, that is really helpful. Things changing. So the next thing I wanted to ask about is, 'cause I'm getting questions about this from patients as well, is what's over the counter? Like they're over the counter sensors. Um, they're calling them over the counter. So talk to me a little bit about those. What, what do we need to know about these over the counter CGMs? 

AMBER: Yeah, so they're actually calling them biosensors.  Um, you don't need a prescription for them. They're available online usually through some sort of subscription service. Um, they're, it's no reader or receiver with them like there are with the prescribed uh, CGMs. So you have to go to either like your Google Play store or your app store depending on your smartphone platform and download the app in order to use them. Uh, and then they don't necessarily have alarms to them that, so they're meant for people more that aren't taking insulin. Or you know, people that might even not have diabetes. Like they might have pre-diabetes or maybe they have, they're moderate. They're trying to monitor some sort of metabolic thing. But they are not approved for diagnosis. So it's important to call out that they're not approved for that You know, you cannot diagnose off of 'em. You should follow the guidelines for that instead of just going off of a CGM. But they're called Dexcom's version of this is called the Stelo. And that one lasts 15 days. And then, um, Abbott's version is called the Lingo and it lasts for 14 days. 

SARAH: Nice. So these are for people not taking insulin. And the big difference is the alarms. It's important to remember. Okay. And make sure their patients know that.

AMBER: Well it's kind of fun. Even with Stelo I've had the opportunity to wear the Stelo. Uh, it'll try to give you, uh, tips on preventing the glycemic spike after you eat.

SARAH: Oh, That's cool. 

AMBER: Like it told me to eat my salad first and that, you know, if I was gonna have salad or that kind of thing. So there's a little bit of different information built into these. Um, More teaching. More teaching. Yeah. 

SARAH: Excellent. That's very cool. 

AMBER: But people can use their healthcare savings accounts for these if they've got them nice to get to cover 'em. 

SARAH: Nice. And I think we talked about cost being around a hundred dollars a month. Um, and then you had mentioned the subscription plans. It might be less than that. 

AMBER: Yeah, I'm, I don't know for sure with Lingo, but I know, um, Stelo that, um, it's like $99 if you don't for two sensors if you don't subscribe. And then if you do subscribe it's around $89 a month. 

SARAH: Okay. Alright. I think those are really neat options. I think this was very helpful. Things change so fast. 

AMBER: They do. I mean technology is ever changing in the field of diabetes. So it's uh, a lot to, to follow sometimes. 

SARAH: Yeah. Yeah. This was really helpful. Thank you. Thanks Dr. Healy. 

AMBER: You're welcome. 

SARAH: Alright, so I think that concludes our updates to CGMs. Feel free to reach out if you have any further questions or you have any other things you want to know about what's, what changes are coming with CGMs. So we have our lovely expert that we can ask, um, if we need any further assistance. And thanks Dr. Healy.

AMBER: Thanks for having me.
 
SARAH: Thanks for joining us.