Written and clinically reviewed by Marissa Town, RN, BSN, CDCES
Diabetes technology has completely transformed in the last ten years. Continuous Glucose Monitors (CGMs), Flash Glucose Monitors (FGMs), Hybrid Closed Loop Systems (HCLs), all help people with diabetes manage blood sugars more easily.
But when is the “right” time for someone to start a new diabetes technology? The answer, as with most things related to diabetes, depends on the person. This answer also hinges largely upon access to a provider who will prescribe the technology and coverage of the device by insurance. For a while in the United States, there was also a barrier of being in “good enough” control or being too “out of control” that would determine if your insurance would cover the costs of insulin pumps or CGMs, making the access hurdle more difficult to clear.
The T1D Exchange collected data from over 20,000 people in the United States with type 1 diabetes and the data was detailed in their 2019 publication, “The State of Diabetes Management and Outcomes from the T1D Exchange from 2016-2018.”1 The data showed that only 17% of children and teenagers were meeting the American Diabetes Association (ADA) recommendation for goal HbA1C of <7.5% (<58 mmol/mol), and only 21% of adults met the goal of <7% (<53 mmol/mol).1 It also showed that insulin pump use only increased from 57%-63%, where use of CGM increased from 7%-30%; and that across all device uptake there were significant racial disparities.1 (For more on racial health disparities in diabetes, see here.)
This spurred further research about how more people with diabetes can gain access to diabetes technologies. Some researchers, including pediatric endocrinology psychology researchers at Stanford University, focused on clinician readiness and barriers to prescribing.2-3 Research Coordinator Monica Lanning, who worked on these studies, states that, “CGM is a great tool for people with diabetes that has been shown to improve glycemic and quality of life outcomes. However, many clinicians do not feel comfortable addressing patient barriers to CGM use, especially when it comes to cost.”
The latest studies show that people with diabetes have better outcomes when they have access to technologies. In a randomized controlled trial (RCT) at five clinic sites in Canada looking at whether or not CGM and pump should be started at the same time or staggered, it was shown that CGM use was better if both were started at the same time, and that CGM use was associated with improved HbA1C.4 Other studies, in Germany5 and in California6, showed that starting diabetes technology as soon as possible after diagnosis improves glycemic outcomes.
If you are a person with diabetes reading this, or someone who loves someone with diabetes, our advice is to stay educated on what is available to you and to talk to your healthcare team about your options. You can find a lot of unbiased information on diabetes devices at diabeteswise.org.
If you are a healthcare professional who cares for people with diabetes, we recommend you look into ways to learn more about the devices and how to optimally help your patients with these devices. Dr. Anne Peters, diabetes expert and adult endocrinologist in Los Angeles, published this article aimed at helping healthcare professionals integrate diabetes technology in clinical practice.