Dr. Tomas Walker, a diabetologist with decades of experience working with type 1 patients and current Senior Medical Director for Dexcom, is confident he knows what is the most important technology for people living with diabetes.
“If you have to pick one, you give them CGM,” he told us in an interview with T1D Exchange Glu. “I love insulin pumps, but at the end of the day, there is nothing that you can do with an insulin pump that you cannot do with a syringe if you are motivated enough.”
Walker, of course, works for a CGM company, but he also has years of experience as a doctor. Prior to joining Dexcom, Dr. Walker worked as a clinician and a diabetologist for more than twenty years, giving him plenty of time to observe the challenges, technical advances, and continuing struggles of patients with type 1 diabetes. One of the things that disturbed him most was the fact that even as injection, infusion, and monitoring technology improved, people continued to suffer – and even die – from hypoglycemic episodes.
High blood sugars generate the vast majority of long-term complications for patients, but extreme hypoglycemia is the most dangerous short-term condition for people with type 1 diabetes.
“Patients still die from this at a far higher rate than they should,” Walker said. “Active alerts and alarms reduce the risk of hypoglycemia, particularly at night, when you’re most vulnerable. You’re not awake, you’re not paying attention and you can have a severe hypoglycemic event and, unfortunately, it still happens all the time.”
Research supports the critical importance of CGM technology
New research supports Walker’s views, as scientists and clinicians draw on the increasingly large body of data generated by sensor technology. A joint study between U.S. and Czech Republic-based researchers looked at four different strategies for treating type 1 diabetes:
- Real-time continuous glucose monitoring with multiple daily insulin injections
- Real-time monitoring with insulin pumping or other infusion systems
- Self-monitoring of blood glucose with a traditional meter and injections
- Self-monitoring with a traditional meter and an insulin pump
The three-year clinical trial assessed a range of key markers to measure the effectiveness of these treatment strategies, including HbA1c, time in range, and incidents of severe hypoglycemia.
The study’s findings showed that those using real-time continuous glucose monitoring were able to substantially improve their HbA1c and time in an optimal blood sugar range, regardless of whether they used insulin pump/infusion technology or multiple daily injections.
The past – and future – of continuous glucose monitoring
Walker’s experience with Dexcom products goes back to the release of the Dexcom Short-Term Sensor (STS), the first real-time glucose monitor to be sold in the U.S., in 2006. He began using the STS with patients within weeks of its full release.
“I began using them in patients and I recognized that this tremendous amount of information was going to completely change how we understand and manage diabetes,” he said. “It took a lot of commitment in the early days. Those systems worked, but they had issues. I became quite an advocate for the whole concept of continuous glucose monitoring technology.”
After several more years of work on the clinical side, Walker joined the company as a medical director.
More than 13 years later, Dexcom is now moving into its seventh generation of glucose-sensor technology, building on the lessons learned in the research and development process as well as from patient feedback, which Dexcom has said is integral to its design philosophy.
Building a better CGM
While the full details of the upcoming G7 are not yet public, we do know that it is planned to be much thinner and have a lower-profile than the G6. The sensor will also be fully disposable, with each unit containing its own discrete battery, transmitter, and processor.
“As part of learning to code the sensors, to pair them, we began to look at the ability to make the entire system disposable,” Walker told Glu. “There was a pathway to make the entire unit a disposable unit, which would improve the patient experience…I can’t tell you how often we get called that someone accidentally threw away their transmitter. It happens all the time.”
In addition to the practical usability benefits, the smaller disposable transmitter allows for simpler engineering and smaller batteries, which currently represent a significant challenge in space and power management.
At the end of the day, however, it’s not just about technology, development, and improving the product. For people with type 1 diabetes, it’s often access to technology and consistent supplies that are most important. There’s also an entire, underserved market of people with type 2 diabetes who are just beginning to experience the benefits of CGM technology.
“This technology needs to be more acceptable, more available to people with both type 1 and type 2 diabetes, and we need to change the curve,” said Walker.
In recent years, Dexcom and Medtronic have been joined by other diabetes tech companies, Abbott and Senseonics, in the CGM marketplace, and the options for continuous glucose monitoring have multiplied in less than a decade and a half since the 2006 release of the STS. Research like the Czech-U.S. study only adds to the clinical argument that CGM technology should be accessible for and utilized by people with diabetes to prevent catastrophic events of hypoglycemia.
“Dying from hypoglycemia related to your insulin…today is not acceptable,” Walker said. “We have technology to change that.”