Blog Post | February 2020

dQ&A CGM Series Part 1: The Tidal Wave of CGM

 

At the J.P. Morgan Healthcare Conference last month, Dexcom and Abbott both disclosed rapid annual growth for continuous glucose monitoring (CGM), which now encompasses billions of dollars of revenue. Dexcom CEO Kevin Sayer said that the question he often gets asked by financial analysts is “Are you out of patients?” But dQ&A research shows that we are only seeing the beginning of a massive wave of CGM adoption.

The early adopters for CGM were intensively managed patients, mostly people with type 1 diabetes in the United States. But now we see rapid growth in type 2 patients and in overseas markets. The growth is both patient- and healthcare provider-driven.

In the following article, Part 1 of our CGM series, we discuss the tidal wave of CGM – the scale of growth and the reasons behind its adoption. We get to grips with the features of CGM and discuss what could drive growth in the future. In Part 2, we will talk about CGM metrics and AGP, how to best use the technology to improve outcomes, and barriers to CGM adoption.


Understanding the CGM Tidal Wave – The Transition to the Standard of Care

The Rise of CGM

At the end of last year, the American Diabetes Association (ADA) released its updated 2020 Standards of Care, which include more details on time in range, consensus CGM metric goals, and ambulatory glucose profiles (AGPs). The new Standards of Care also highlight CGM and “CGM-assisted pump therapy” as tools for preventing hypoglycemia.

Endocrinologists are on board with this guidance. The figure from our annual study shows the statistically significant increase in endocrinologists strongly agreeing that CGM is becoming standard of care.

In parallel with this endorsement, patients are adopting CGM at an increasing rate. The figure below, from our quarterly USA Patient Tracker, shows how CGM growth has taken off in insulin users since 2018, with a higher growth rate in type 2 diabetes. Penetration is still much higher in type 1 diabetes.

Note: CGM penetration in the dQ&A US Patient Panel indexed to Q4 2015 = 100. The slope shows relative rate of growth within each segment.

Growth Drivers: Reasons for Adoption and the Top Benefits of CGM

The reasons behind this growth are clear from our quantitative patient research. New starters on CGM see value in four key areas:

  • improving overall glucose control,
  • avoiding hypoglycemia,
  • being able to check glucose levels more frequently,
  • reducing fingersticks.

To delve deeper into the hypoglycemia-related benefits of CGM, we conducted a Hypoglycemia Attitudes and Behavior Scale1 (HABS) study with n=4,539 people with diabetes. It revealed that CGM usage is significantly associated with increased confidence, decreased avoidance of hypoglycemia, and lower hypoglycemia anxiety.

Opportunities for Future Expansion: Most Important Features and Desired Improvements

dQ&A has years of data showing that accuracy and reliability are the most important CGM product attributes for users. But on these measures, CGM has clearly turned a corner in terms of delivering a mainstream product, particularly now that fingersticks have been drastically reduced in number, if still not eliminated entirely. So, what of the future?

In our recent survey of n=242 endocrinologists in the USA, we asked what Dexcom and Abbott could do to win more business. Analysis of unprompted write-ins shows that the top two factors are:

“What can ____ do to win more business?” Dexcom Abbott
Top two factors for endocrinologists (n=242)
  • Longer sensor life
  • Better integration (with pumps, closed loop, etc.)
  • Provide alerts and alarms
  • Improved accuracy

 

CGM users in our US patient community give similar answers for their top two desired improvements to their CGM devices:

“..please select your most desired improvements..” Dexcom Abbott Medtronic
Current CGM users (n=1,670)
  • Longer sensor wear
  • Integration with my insulin pump
  • Better sensor adhesive
  • Better accuracy
  • Better accuracy
  • Longer sensor wear

 

All of the CGM manufacturers are promoting the wider utilization of CGM, including in people with type 2 diabetes and the less intensively managed. There are clearly cost and access barriers to be addressed (more about this in Part 2 of our CGM Series), but here’s what CGM non-users in the USA and Europe say their top three important factors in choosing a CGM would be, if cost were not a barrier:

Future CGM System – Top Three Important Factors USA CGM non-users (n=2,447) Europe* CGM non-users (n=754)
First place Sensor that is comfortable to wear (48%) High reliability (45%)
Second place High reliability (39%) Ability to pair with technologies (e.g., smartphone, watch, Fitbit) (39%)
Third place Elimination of fingersticks (36%) and best available accuracy (36%) Elimination of fingersticks (38%)

(*Survey was conducted in the UK, France, Germany, Netherlands, Sweden, Norway, and Denmark)

These data from endocrinologists, CGM users, and CGM non-users highlight people’s desire for increased sensor comfort and wear time, as well as the importance of continuing to promote device interoperability and connectedness. They also underline again how important the elimination of fingersticks has become as CGM transitions to standard of care.

This article just skims the surface of our data on glucose monitoring. We’ve conducted ten years of research on CGM usage, satisfaction, preferences, switching behavior, likelihood to acquire future models, and more, and we can analyze this data for very specific sub-segments of the diabetes population. We also possess deep knowledge of insulin, oral therapies, GLP-1s, and pumps.

To learn more about our patient tracking studies in the US, Canada, and Europe; our research with healthcare providers; and our custom qualitative and quantitative capabilities, please contact us at info@d-qa.com. We’d be delighted to talk with you about how we can help you answer your most important diabetes questions.

Stay tuned for Part 2 of this series where we will take a look at AGP and CGM metrics, their utility, and barriers to CGM adoption.

Thank you to all of the community members who participated in these research studies!

  1. The Hypoglycemic Attitudes and Behavior Scale is copyrighted by the Behavioral Diabetes Institute.

 

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