Should people without diabetes be allowed to wear CGMs?
The other day I was poking around the internet looking up something not related to T1D when I came across an article by Ben Greenfield about his use of a Dexcom CGM. According to his website, Ben is “ a biohacker, human body and brain performance coach, ex-bodybuilder, Ironman triathlete, professional Spartan athlete, anti-aging consultant, speaker and author of [a] New York Times Bestseller.” Intrigued?
My first response was, wow this is so cool! But then I read the comments and there were a few angry Type 1 Diabetics.
CGMs are amazing tools for showing real-time blood sugar levels, even for non-diabetics. Even my endocrinologist confessed that she was surprised by how high her levels were after eating certain less-healthy foods. (As my old nutritionist would say, pizza is not a “strong” choice.) I’m all for people making more-informed decisions about what they consume and being more proactive about their health.
It would not surprise me if one day everyone has some estimate of their blood sugar from a device. After all, there was a rumor just last week that Apple might buy Dexcom.
Anyway, so what’s the problem here?
The crux of the T1D naysayers’ comments essentially boiled down to the fact that it’s not fair for Ben to have a Dexcom when so many T1Ds who need them don’t have access to CGMs. Well, unfortunately, our healthcare system is incredibly inequitable, especially for diabetics. Ben is paying out of pocket. It would be hard to argue that because he has a Dexcom he takes a Dexcom away from someone else. The people without CGMs don’t have them because they can’t afford them. We can and should advocate for better healthcare in the U.S. and improved access to tech for T1Ds, but it’s hard for me to find fault in a rich person simply buying a CGM.
What I do take issue with is that Ben linked to another article that discussed how someone fooled his doctor into giving him a prescription for a CGM by taking insulin to get a low blood sugar. Not only is intentionally overdosing on insulin to get a CGM INCREDIBLY DANGEROUS, it’s also insurance fraud. People with T1D have enough trouble getting insurance companies to provide us with access to technology as it is. We don’t need unnecessary insurance claims for CGMs to cause insurance companies to question their necessity even more.
Further, any T1D who uses social media knows that there is a black market for T1D tech and supplies. This market exists because of a market failure — when some people don’t have coverage and costs are so high, it becomes lucrative for those with coverage to sell. Additionally, because of the terrible service and infrastructure of medical supply companies, many diabetics find themselves short on supplies before their next shipment arrives. (I’m actually dealing with this right now, ugh.) Bottom line: we don’t need non-diabetics entering the black market for CGM supplies and pushing up prices. If the price gets high enough, economically-disadvantaged diabetics will have a strong incentive to sell and put their health at risk. If you are a non-diabetic looking to get a CGM, please do not go to the black market. You can always reduce the cost of sensors by extending them past the 10-day period.
On the positive side, the increased interest in CGMs by biohackers will undoubtedly benefit the T1D community. More demand will drive costs down and spur innovation. T1Ds are accustomed to needles by necessity; the general population is not. The more “normal” people who want to see their blood sugar, the more likely it is that someone will come up with a less invasive solution than sticking a wire in your arm with a big needle. Pretty sure this will happen sooner than a cure for T1D. ;-)
*Credit to my friends over at CGM in the Cloud Off Topic for many of these points. If you’re in the group, search for my name and check out the thread.
