‘So, how many of you have patients who make treatment decisions based on their CGM?’

This was the question posed by one of the healthcare professionals speaking at this afternoon’s Dexcom symposium at ISPAD.

A few hands were raised. Not many; only a few in the packed room. Two of the hands that shot up the fastest belonged to a colleague and me, both of us referring to ourselves as the ‘patients’ – or perhaps each other.

We looked at each other and half smiled, shaking our heads. We knew the answer – we knew what the truth was. The response in my head was ‘Of course we do. Of course. I treat based on arrows telling me I am heading for a low without checking my BGL – I did it just before walking into the session.’

The question came after the announcement that treatment decisions could be made based on sensor readings from the new (yet to be released in Australia, but launched already in the US and in some European markets) Dexcom G5 CGM.

There has been much excitement from HCPs presenting about this new development in CGM – both at this conference and at EASD. It has huge implications because essentially, it is removing the need to do finger prick BGL checks, apart from the required twice-daily calibrations.

But it has been presented as if people using this technology have never, ever thought before to treat based on what their CGM data is displaying.

I doubt that any person using CGM has found this announcement particularly startling or surprising in any way.

But this is often the case. The release of new evidence or new guidelines or new data heralds a shift in ‘approved’ diabetes management or techniques and suddenly, there it is on all the shiny brochures and in all the shiny presentations.

And the people with diabetes who have been doing this, or have known this or understood it to be true from some time, look at each other slightly puzzled at what all the excitement is about.

I understand the importance of a strong evidence base. And I understand the need to be safe – especially as part of regulatory and approval processes. But sometimes, I can’t help but wonder why it takes so long for the evidence to catch up with what is already known, and match the anecdotal experiences that we hear and share.

It was great to have the speaker acknowledge that the show of hands after her question was probably not accurate of what was really happening.

‘You know your patients are probably doing it and just not telling you, right? They don’t want to be reprimanded for not doing what they are supposed to, but they probably are making treatment decisions based on their CGM data.’

It was probably the most frank thing we heard in that session – the twofold acknowledgement that PWD are already doing something that works but is ‘off label’, but are afraid to tell our HCPs about it, lest we get told off.

This time, when my colleague and I looked at each, we smiled widely. And we nodded. Because we knew it to be true.

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