FDA clears first over-the-counter continuous glucose monitor • Hacker News Board

Re: FDA clears first over-the-counter continuous glucose monitor

#181

Post by user_7832 » Wed, Mar 06, 2024, 9:28 PM UTC

eurleif wrote: post #107

queuebert wrote: post #84

Earlier quoted context omitted.

False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.

If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information.

> If having more information leads to worse outcomes, that's fundamentally a problem with how you're responding to the information, not with having the information.

Not necessarily.

Rohin Francis (Medlife crisis) has I think a video on overtesting, but for example, if you have a new technology that tests and suspects a tumor, which results in CT scans for patients, if millions of users use this tech there's a likely non-zero number of people who may get cancer from the CT exposure.

"What about those who actually had the tumor?"

Well it's possible that 99% of these cases would've been symptomatic anyway in a few more months.

By explanation isn't the best, but over-medication is not a non-issue.

Re: FDA clears first over-the-counter continuous glucose monitor

#182

Post by tetramer » Wed, Mar 06, 2024, 9:29 PM UTC

gtirloni wrote: post #126

queuebert wrote: post #84

Earlier quoted context omitted.

False positives in medicine can cause unnecessary interventions that carry their own risks. Believe it or not, there is an optimum level of ignorance for maximum health.

The unnecessary interventions are done by licensed doctors? Why?

You don't know if it's a false positive or not until you do further interventions. Realizing it's unnecessary is only evident in hindsight.

E.g. CT scan shows an incidental, tiny lung nodule. You do a biopsy. Unfortunately, during the process of getting a biopsy, you develop a pneumothorax (an uncommon but well-known complication of a lung biopsy) and need a chest tube, hospitalization, etc. You get discharged and you're fine, but man, that wasn't fun. Biopsy comes back negative for cancer. Nodule goes away on its own with time.

Edit: that being said, I'm excited about OTC CGMs! But the "data" we have in medicine is not as accurate as other fields and always subject to false positives/negatives.

Re: FDA clears first over-the-counter continuous glucose monitor

#183

Post by jonlucc » Wed, Mar 06, 2024, 9:30 PM UTC

thecosas wrote: post #164

T1D here who has been using Dexcom G6 for many years now. Interesting to see the differences between Stelo and G7 which are built on the same platform. Curious if anything is driving the increase in wear time other than battery life savings from reporting back fewer readings. CGM: G7 / Stelo Wear time: 10 / 15 days Time between readings: 5 / 15 minutes

I'm not sure how much I can say; I don't work for a CGM company, but my company is very interested in diabetes. There are non-device reasons you can't use a CGM indefinitely. The site becomes less reliable over time, and it varies from peron to person. I'm not sure if the Stelo has addressed any of those, or if the G7 was overly cautious, or something else, but there are biological things happening at the site that affect the time too.

Re: FDA clears first over-the-counter continuous glucose monitor

#184

Post by thecosas » Wed, Mar 06, 2024, 9:34 PM UTC

coldpie wrote: post #87

bsder wrote: post #49

Earlier quoted context omitted.

> Each sensor also used a ludicrous amount of plastic for its applicator, like a tennis-ball-sized hunk of hard plastic, that you just chucked in the trash, every week. Erm, let's be a little defensible here. These sensors have to be stored in sterile packaging--that means thick enough to be a barrier. That means it also has to hold the sensor in such a way that a palette can be gamma irradiated. It also needs to be…

Eh, maybe, but the bulk of the applicator is just empty plastic molded to fit an adult's hand. I have to believe they could figure something less wasteful out (reusable applicator?) if they wanted or needed to. Regardless, it was just another downside for me weighed against the relatively few upsides that made me quit using it. It felt terrible to chuck all that in the trash, especially when I'd have to do it two day…

T1D currently using G6 / Omnipod Dash / open source Loop app.

The worst is every 90 days when I get a new G6 transmitter. It comes in a box the size of Two video tapes stacked on top of each other. I've tried reaching out to my mail-order pharmacy about it since I know there are smaller versions of it (or used to be), but nothing yet.

From what I've seen, the packaging for Dexcom G7 and it's applicator seems much smaller than G6's.

Side note: That applicator for G4 instilled fear every time I had to use it and I was already 20 years into T1D by then. The spring loaded applicators in G6/G7 are a big improvement as far as end user experience IMO :-)

Re: FDA clears first over-the-counter continuous glucose monitor

#185

Post by TeaDrunk » Wed, Mar 06, 2024, 9:35 PM UTC

psychlops wrote: post #128

Aurornis wrote: post #111

Earlier quoted context omitted.

> Fasting is problematic to the medical industry because it is zero cost. No, fasting is problematic because people don't like it. Health conscious people don't understand how much resistance the average patient has to advice about lifestyle modifications, or how difficult it is to get patients to adhere to recommended lifestyle changes. A good example is sleep apnea and CPAP machines: In theory, a CPAP machine shoul…

It's also rare for a doctor to tell a person they are too fat and to lose weight. The assumption (and most cost effective solution) is that patients just want a prescription for something and be sent on their way. US healthcare is crisis focused, not health focused.

> It's also rare for a doctor to tell a person they are too fat and to lose weight.

Genuinely curious... have you ever been an obese person? Every fat person I've known have told me they're constantly shamed about being fat in medical settings, some to the point where they actively avoid going to a doctor anymore because they've given up on anything beyond being told they're fat.

Re: FDA clears first over-the-counter continuous glucose monitor

#186

Post by user_7832 » Wed, Mar 06, 2024, 9:35 PM UTC

mft_ wrote: post #43

saagarjha wrote: post #26

Earlier quoted context omitted.

What happens when an officer confiscates your glucose monitor today? I assume you die and they claim they did it for some valid reason or the other.

Type 1 diabetics have been managing their insulin for decades with occasional blood sugar testing - i.e. certainly not testing for every dose. They’d be fine to manage things for a period without a confiscated monitor.

> Type 1 diabetics have been managing their insulin for decades with occasional blood sugar testing - i.e. certainly not testing for every dose. They’d be fine to manage things for a period without a confiscated monitor.

This is similar to saying "X person can survive without y medicine which has only been around for 10 years". Or "people survived fine without seatbelts for so many years".

That's a classic survivorship bias, because a ton of diabetics didn't survive, who'd possibly have a much higher chance of surviving today with current tech. Heck, I personally know the brother of a late diabetic who would've been alive today if he had a phone connected to a CGM because of it's low glucose alarm function.

I understand HN is a place for discussion, but in potentially deadly situations like this, it's worth avoiding to make statements against medical care.

Re: FDA clears first over-the-counter continuous glucose monitor

#187

Post by znpy » Wed, Mar 06, 2024, 9:37 PM UTC

hlfshell wrote: post #119

znpy wrote: post #102

Earlier quoted context omitted.

What's the lifetime of a single device? Are you supposed to remove it before a shower and reapply it later?

No, it's mostly water proof. You wear it through showers and even swimming for 2 straight weeks. The adhesive is pretty good; rarely does it come off on its own prior to say, a week and a half in. It holds 8 hours of data (1 reading per minute) and you can just hold up your phone to read the last 8 hours of data for your overall data.

thanks for the reply!

Re: FDA clears first over-the-counter continuous glucose monitor

#188

Post by migro23 » Wed, Mar 06, 2024, 9:37 PM UTC

sdo72 wrote: post #157

migro23 wrote: post #136

Earlier quoted context omitted.

> In a fire, we see firefighters, that doesn't mean firefighters cause fire. In diabetic patients, we see high glucose level. That doesn't mean eating high GI food causes someone to have diabetes. This is correct but probably not in the way you think. It is not the glucose in and of itself that is the problem but the level of the hormone insulin circulating around your system that is at the root of Type II diabetes.…

Thank you for the detail :). And yes, I do believe lacking of fibre is one of the key important factors causing many kinds of diseases, and the modern diet is totally missing lots of fibre.

You're welcome. I must add that I am not a doctor so take the above with the appropriate level of skepticism on your behalf. I am only summarising what I have learned from books and have omitted A LOT of detail.

Re: FDA clears first over-the-counter continuous glucose monitor

#189

Post by crimsontech » Wed, Mar 06, 2024, 9:37 PM UTC

csours wrote: post #178

guidopallemans wrote: post #55

Earlier quoted context omitted.

I used to have this problem as well, so I talked it over at my endo office. They suggested that I order some specially shaped stickers to keep them on, but instead I just bought some Kinesiology Tape (hansaplast, but also exists store-brand). 10cm of that works perfectly, even for heavy contact sports combined with sweating (and many showers).

Yup, I tried this. I sweat A LOT

I tried different tapes, Kinesiology tape didn’t stick for me but Hypafix did, I can’t get this stuff off without soaking it.

If you ever want to give it another go, try Hypafix. I tore my skin the first time and quickly learned to soak it and use soap to remove the GCM.

Re: FDA clears first over-the-counter continuous glucose monitor

#190

Post by thecosas » Wed, Mar 06, 2024, 9:37 PM UTC

user_7832 wrote: post #174

thecosas wrote: post #164

T1D here who has been using Dexcom G6 for many years now. Interesting to see the differences between Stelo and G7 which are built on the same platform. Curious if anything is driving the increase in wear time other than battery life savings from reporting back fewer readings. CGM: G7 / Stelo Wear time: 10 / 15 days Time between readings: 5 / 15 minutes

I seem to remember there was a "trick" with the g6 where you remove and reinsert the transmitter to get it to last longer... I suspect the time estimates are quite conservative.

Yep, I've definitely used my G6 for two sessions using "tricks". It would definitely get wonky towards the end of that time period, but it worked.