US Pharm. 2020;45(11):15.

Avoiding Adverse Effects of Diabetes

Under regular conditions, our bodies produce the hormone, insulin, to help store glucose generated from the food we eat. Diabetes mellitus is a chronic health condition associated with elevated levels of blood glucose (blood sugar) caused by inadequate insulin production (type 1 diabetes) or insulin resistance (type 2 diabetes). Failure to control blood glucose in the long term can lead to adverse consequences for the heart, eyes, nerves, and kidneys. Effective diagnosis and management of diabetes requires accurate measurement of blood glucose levels. For individuals who need insulin therapy to control blood glucose levels, measuring blood glucose helps guide insulin dosing.

Monitoring Glucose Levels Helps Diabetes Management

Self-monitoring of glucose (SMBG) levels using a fingerstick allows patients to test at home and report glucose to their healthcare provider. Laboratory testing of glycated hemoglobin (HbA1c) provides an indication of the average blood glucose level over a two-to-three-month period and is used to diagnose diabetes and assess current treatment. Neither SMBG or HbA1c can show blood glucose fluctuations throughout the day or identify when blood glucose levels drop too low (hypoglycemia). Additionally, SMBG relies on the person remembering to test at the right time and the correct frequency, meaning that hypoglycemic and hyperglycemic events can be missed.

Continuous Glucose Monitoring Delivers Real-Time Data

Real-time continuous glucose monitoring (CGM) is a glucose-monitoring modality that continuously tracks glucose levels as frequently as every five minutes. A CGM works via a sensor applied under the skin, typically on the stomach. It does not measure blood glucose levels; instead, it measures the interstitial glucose level. A transmitter snaps into the sensor pod and wirelessly sends glucose data to a nearby receiver or smart device. Real-time CGM data can inform the patient how their glucose level changes after a meal, under stress, or after exercise. There are several CGM devices available on the market. This teaching aid will focus on the Dexcom G6 CGM System^a (also known as Dexcom G6).

Dexcom G6 CGM System Authorized Without the Need for Fingersticks^*

The FDA authorized the Dexcom G6 CGM System in March 2018 for patients ages 2 years and up. Dexcom G6 includes a sensor that is inserted just under the skin with a simple, push-button auto-applicator. Glucose data are transmitted to a nearby receiver or smart device^b as frequently as every five minutes through a transmitter snapped into the sensor pod. The Dexcom G6 app^b enables users to quickly see glucose data, as well as the direction and speed of glucose change, so that they can adjust and regulate diet and insulin treatment—all without fingersticks.^* Patients can set up customizable alerts so they can be notified when they are high or low.

^* If your glucose alerts and readings from Dexcom G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.

Accessing and Sharing Glucose Data Is Easy With Dexcom G6

Dexcom G6 CGM users can share their data with up to 10 followers, including family, parents, or healthcare providers or professionals, via a separate Dexcom Follow app. The device can also integrate with automated insulin delivery system that increases insulin delivery when glucose is predicted to go high or is high and decrease or suspend insulin when glucose is predicted to go low or is low.

Dexcom recommends that all parts and components of the Dexcom G6 CGM System be used according to the specifications in the package insert to prevent any unexpected effects. A prescription from a physician or (in some states) a pharmacist is required. The first prescription should list three components: the receiver, the wireless transmitter, and the three-pack of sensors. Most commercial insurance plans cover the Dexcom G6 under the medical or pharmacy benefit. Medicare covers the Dexcom G6 when the device is deemed medically necessary.^c

If you have questions about prescribing, ordering, or using your Dexcom G6 CGM, talk to your healthcare practitioner or visit your local pharmacy.

BRIEF SAFETY STATEMENT: Failure to use the Dexcom G6 Continuous Glucose Monitoring System (G6) and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. If your glucose alerts and readings from the G6 do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. Seek medical advice and attention when appropriate, including for any medical emergency.

^a Dexcom, Dexcom G6, and Dexcom Follow are registered trademarks of Dexcom, Inc. in the United States and/or other countries.
^b For a list of compatible smart devices, visit dexcom.com/compatibility.
^c For more information on Medicare coverage for Dexcom G6, visit dexcom.com/g6-medicare.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

To comment on this article, contact rdavidson@uspharmacist.com.