Medtronic's Response to Zachariah Kramer's Letter Cautioning Against Unrealistic Expectations About CGMs

Jul 16, 2008

What follows is Medtronic's response to Zachariah Kramer's letter to Diabetes Health cautioning against unrealistic expectations about CGM systems.


Medtronics Diabetes’ Response,

June, 2008

Diabetes therapy has undergone a number of significant advances over the years.  Patients are now more than ever empowered to manage their diabetes with the advent of continuous glucose monitoring (CGM).  As with any new technology or therapy, there are criticism and challenges.  All of these concerns are legitimate, but I believe the clinical benefit and improved protection associated with CGM vastly outweigh those concerns.

Diabetes Mellitus is a chronic disease that is best managed by the patient who has both access to continuous information needed for continuous decision making and evaluation as well as guidance from a team of care givers. It can not be managed successfully blind to vital information such as undetected high and low blood sugars, time spent above or below normal glucose targets or the response to a multitude of life events. If managed by individual, episodic data we as healthcare professionals are unable to successfully tailor diabetes treatment to the individual needs and responses of each person with diabetes. Without the added information from CGM, diabetes as a chronic disease will continue to be managed unsuccessfully using acute care models.

The clinical understand of diabetes has also changed because of CGM.  Clinical evidence has shown that CGM use can lower A1c by as much as one percentage point.   That’s significant when you consider that for every point reduction in A1c long-term side effects are reduced by 25 percent.  But even more exciting, continuing clinical evidence points to the importance of glucose rate of change, area under the curve and glucose variability as components of optimal diabetes control.  Without CGM to enlighten us, we would never have learned about these silent variables of diabetes health.  

In the short-term, CGM will not replace the fingerstick meter.  It is true that companies like Medtronic are seeking ways to reduce or do without those inconvenient finger pricks, but those studies will require multiple years of significant clinical scrutiny.  Instead, I’d shift the dialog to more about the value of this new technology, rather than what it replaces.  

Let me illustrate the point.  Say you’re going to bed and take a fingerstick reading.  Your meter reads 125 mg/dl reading.  What do you do?  You ask yourself, “Am I going up?  Am I going down?”  Worse yet, “Should I give myself a shot, or do I run the risk of running high all night?”

With CGM, you have the added information of trending and directional arrows.  You know EXACTLY where you’re headed.  Also, with the built-in alarms, even if your glucose takes a turn for the worse, the device will wake you up before your situation becomes a real emergency.  Since when could a fingerstick meter do the same?

Cost is the most compelling argument.  I agree that new technologies always cost more than the standard of care.  CGM is still in its infancy, and as demand increases costs will come down.  We at Medtronic are working aggressively to reduce production costs and secure broader health insurance coverage to address this very real concern.  

The tide has shifted as CGM technology has continued to prove its benefit.  The emerging consensus among physicians is no longer “if” but rather “when” this technology will become widely adopted and accepted as the standard of care.  We all need patience and perseverance to ensure CGM therapy reaches those who desperately need the power of real-time diabetes control.


Alan Marcus, MD
Chief Medical Officer
Medtronic Diabetes

Click Here To View Or Post Comments

Categories: A1c Test, Blood Sugar, CGMs, Diabetes, Diabetes, Type 1 Issues

Take the Diabetes Health Pump Survey
See What's Inside
Read this FREE issue now
For healthcare professionals only
  • 12th Annual Product Reference Guide
  • Insulin Syringe Chart
  • Insulin Pen Needles Chart
  • Fast-Acting Glucose
  • Sharps Disposal
  • Blood Glucose Meters Chart
  • Insulin Pumps Chart
See the entire table of contents here!

You can view the current or previous issues of Diabetes Health online, in their entirety, anytime you want.
Click Here To View

See if you qualify for our free healthcare professional magazines. Click here to start your application for Pre-Diabetes Health, Diabetes Health Pharmacist and Diabetes Health Professional.

Learn More About the Professional Subscription

Free Diabetes Health e-Newsletter

Top Rated
Print | Email | Share | Comments (2)

You May Also Be Interested In...


Posted by Anonymous on 12 June 2009

too bad that the sugar readings you get is from 20 minutes ago. at the current prices of these technologies, we should focus on replacement. what's the point of having a cgm if you have to prick your finger when you want to be 100% sure of your glucose level. not to mention all the calibration work you have to do before the meter starts working.

am i going up? or down? well, it is not that complicated. one, ask yourself how long ago you injected and compare that to how long the insulin action and peak times. two, check more often.

the idea behind cgms is fantastic but it is not there yet.

Posted by Anonymous on 21 January 2010

CGMs certainly have their place even in their infancy stages. Best use current CGMs is to watch the effects of exercise or certain foods, like the dreaded pasta. I tried current CGM technology and its just not ready for me yet. Real time blood glucose CGMs will make all the difference. The current technology takes its BG values from interstitial fluid which quite frankly is old information. Waiting and hoping for the new tecnology soon.

Add your comments about this article below. You can add comments as a registered user or anonymously. If you choose to post anonymously your comments will be sent to our moderator for approval before they appear on this page. If you choose to post as a registered user your comments will appear instantly.

When voicing your views via the comment feature, please respect the Diabetes Health community by refraining from comments that could be considered offensive to other people. Diabetes Health reserves the right to remove comments when necessary to maintain the cordial voice of the diabetes community.

For your privacy and protection, we ask that you do not include personal details such as address or telephone number in any comments posted.

Don't have your Diabetes Health Username? Register now and add your comments to all our content.

Have Your Say...

Username: Password:
©1991-2015 Diabetes Health | Home | Privacy | Press | Advertising | Help | Contact Us | Donate | Sitemap

Diabetes Health Medical Disclaimer

The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained on or available through this website is for general information purposes only. Opinions expressed here are the opinions of writers, contributors, and commentators, and are not necessarily those of Diabetes Health. Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this website.