Lowcountry residents get into glucose monitoring as non-prescription options arrive

Ad agency vice-president Soraya McKay is a walking advertisement for continuous glucose monitors. She wears one most of the time, even though she does not have diabetes. 

“My mom passed away from dementia a few years ago, and I had been reading a lot about how it's becoming known that uncontrolled glucose has a lot to do with dementia.” 

Her mother had diabetes. Researchers have linked that condition with an increased risk of dementia.

“I just wanted to be proactive. I wanted to see what my glucose looked like. And if it was out of control, I wanted to be able to take steps proactively,” McKay said.

Trend toward glucose monitoring for people without diabetes

The Mount Pleasant woman is far from alone. A growing number of people without diabetes are wearing continuous glucose monitors for health and fitness reasons. 

 

In the past, the devices were almost exclusively used by people with diabetes. They work by inserting a small tube into the top layer of the skin, often on the arm, to measure glucose. It sends information to a monitor that the wearer can read. A patch holds the tube in place. 

Diabetes specialist Emily Rosenberg, M.D., part of the MUSC Health Endocrinology team and an assistant professor in the College of Medicine at the Medical University of South Carolina, said she and her colleagues have discussed the possible effects of people without diabetes using those devices.

“It's a really interesting thing. We've been talking about it for a while. What's going to happen when people start wearing these and they don't have diabetes? What happens if they do have a high blood sugar? Will this lead to more contact with the health care system?” Rosenberg said.

Need for further study and education

Those questions show the need for further study by scientists and education for the public, Rosenberg said.  She cited three areas of concern.

Understanding the monitors’ nuances

While Rosenberg said continuous glucose monitors are generally highly accurate, the beginning and end of a cycle of wearing one can throw off readings. “On the first day of wear and the last few days of wear, they tend to be less accurate. In our patients with diabetes, we say if the sugar seems off, double check with a glucometer.” 

A glucometer measures glucose through a fingerstick sample of blood. Rosenberg said it’s not as comfortable or convenient as a continuous glucose monitor, but it’s accurate. And it can serve as another tool to measure glucose. 

Will a person without diabetes know to take that extra step, using a glucometer, if needed? It’s unclear at this point, Rosenberg said.

Making sense of fluctuations

Rosenberg also raised concerns about whether people without diabetes have enough information to understand the meaning of fluctuations in the monitors.

“One thing that could be problematic is interpreting blood sugars. Overnight blood sugars may be low in people without diabetes. This is normal but may lead to undue concern from the person wearing the CGM." 

Determining target numbers for people without diabetes

Rosenberg’s third concern involved target numbers for people without diabetes using continuous glucose monitors. “The target glucose for individuals with diabetes is between 70 and 180 mg/dL. We tell patients that most of their sugars should be between 70 and 180. We are lacking a lot of continuous glucose monitor data for people without diabetes so we don’t have a clear target range for this population.”

Do monitors for people without diabetes lead to positive changes?

Despite her reservations, Rosenberg said the monitors do have the potential to help people without diabetes improve their health. She’s worn one of the devices, which gave her some insight. 

“I can see how it could shape how you eat, influence your dietary patterns. You see that when you're active, your blood sugar improves. And so it may help modify some of your behaviors. But whether that leads to weight loss, that leads to cardiovascular disease improvement in somebody without diabetes, we don't really know.”

McKay, the ad exec who wears a continuous glucose monitor for health reasons, said it has changed her behavior – and offered some reassurance. 

“I have found that my glucose isn't bad. It stays in a pretty optimized range, but there are definitely certain things that I was eating a lot of that just caused it to go through the roof,” she said.

“Rice and corn spike it so much. I mean, it's like boom - it goes immediately into the red zone. But potatoes don't move it at all. Rice, which I was eating a pretty good bit of, that spikes it a lot. Now, if I eat rice, I'll buy brown rice and quinoa mixed. That solves the problem.”

McKay said the monitor has also led to testing how exercise can help lower her blood sugar. “Taking a walk after dinner for five or 10 minutes, you know, and how much that affects what happens. It's just been an eye-opener.”

Costs are a factor

The cost of a continuous glucose monitor for people who don’t have diabetes can be an eye-opener, too. McKay turned to a website that connected her with a doctor. She started paying about $250 a month for two monitors and got access to an app that let her track what she was eating and get nutrition information. 

But after about six months and hundreds of dollars later, McKay turned to her regular doctor and asked for a prescription. She now pays about $30 a month for continuous glucose monitors.

Non-prescription monitors come on the market

More people may follow suit, either through doctors, like McKay, or through two companies that are starting to sell continuous glucose monitors without prescriptions. Abbott’s is called Lingo. Dexcom’s is called Stelo. Both companies charge $89 for a monthly subscripton.

Both are also making their case to the public. Abbott says in a news release that continuous glucose monitors can allow users to be proactive about their health, help with weight loss, improve sleep and even put users in a better mood. Dexcom says on its website that Stelo “delivers glucose readings 24/7 directly to a smartphone, revealing powerful, personalized insights about glucose health.”

The future of continuous glucose monitors

McKay has no hesitation about continuing to use glucose monitors. “They call people that do this biohackers - people who just want to know what's going on in their bodies. I think it's a great tool. Knowing how much of a detriment uncontrolled glucose can be, I think it's important to know.”

Knowledge is Rosenberg’s focus, too. She wants to know where, from a scientific perspective, the field goes from here. “While they may lead to improvement in diet and exercise on a personal level, we do not have enough data to understand their long-term benefit in this population and whether or not they are worth the cost.”