Thank you so much for spending a few minutes with us here at this Dexcom Product Theater. My name is Viral Shah. I'm an endocrinologist and clinical researcher at Indiana University. So what I'm going to do today is that, in about 10 minutes or so, I want you to really think about what we are doing currently and what we need to do in the future. We need to probably think differently and in terms of type 2 diabetes management.
So let me see. Here are my disclosures. ADA Standards of Care. We all know this part. This is 2026. Literally just copied those words as it is here, and you see that the CGM is recommended at diabetes onset as soon as possible, right? And any time thereafter for children, adolescents, and adults with diabetes who are on insulin therapy. That's level A evidence. They should be. We should offer everybody CGM, once they are on insulin therapy. For non-insulin therapy, it says level C, which I disagree. I think it should be B, and hopefully now we have enough data that will now be A in people with type 2 diabetes.
So CGM is a standard of care, period. But then what's the reality? The reality is this. This is actually, I just used the Google Gemini to create this picture, and you have the source there here so that it's not just a fake data or hallucination. About fifty-five to 60% of people with type 1 diabetes are using CGM, and this is more of a U.S. data. Only less than 20%, or roughly about 22% of people with type 2 diabetes are on CGM. Okay?
I'm going to go back again. If the CGM is the standard of care for both people with type 1 diabetes and type 2 diabetes, why is there a discrepancy in the use of CGM in type 1 versus type 2? And I think the biggest issue here, in my opinion, is that we see type 1 diabetes and type 2 diabetes through a different lens. Okay? And what I mean by that part, I think that there are more similarities in type 1 and type 2 than differences between type 1 and type 2.
So think about that part, at least in my practice and if you have someone with a newly diagnosed type 1 diabetes, you can have a diabetes educator talking to that individual. Your institutions might have a standardized curriculum. Oh, what is insulin? How to take insulin, what's carb ratio, what's correction factor, putting CGM on.
What happens in type 2 diabetes? Oh, you just have a pre-diabetes. I'm going to see you after six months or a year, right? Oh, your A1c is just seven, it's okay. We're going to see you again in about six months. Oh, your A1c is just 7.2, right? This just keeps going on. I think the therapeutic inertia, because we see type 1 in completely different way than type 2 diabetes. So this is a kind of a-- I tried to put this comparison between type 1 and type 2 diabetes, in this illustration here. In my opinion, they are very similar, with one exception or two exceptions, I think.
The underlying pathophysiology is different. One is autoimmune; another one is non-autoimmune. And the second thing is the duration of the progression. So progression from no diabetes to, you can call it pre-diabetes or stage 2 type 2 diabetes to type 2 diabetes takes longer than in type 1 diabetes. But otherwise, all the diagnostic criteria, the glucose thresholds, everything remains the same between type 1 and type 2 diabetes.
So I think it's time for us to now think in a different way that why we are discriminating between type 1 and type 2 diabetes management when it comes to optimizing their glycemia, optimizing their health. And that leads to-- this is the problem, right? So there are plenty of articles. This is just I put like a two here in as a kind of a teaser.
50% of people with type 2 diabetes have at least one microvascular complication when they are diagnosed with type 2 diabetes. Why 50%? That's a lot, right? Half of this population would have at least one microvascular complication. It's because, as I mentioned, oh, you have a pre-diabetes, it's a 5.9; you're okay. I'm going to see you after a year. That year becomes many years, and by that time that glucose is glucose, and glucose is dangerous over time. And so I think that leads to those complications.
So again, it's time for us to change our mindset and put that into the perspective of staging type 2 diabetes like what we do staging in type 1 diabetes. And so that's what we proposed in the The Lancet Diabetes & Endocrinology commentary there.
And what I'm saying or Tadej Battelino, Moshe Phillip, and Rich Bergenstal were my partners in crime here for this commentary, is that the underlying beta-cell defect is the key in type 2 diabetes progression. Don't forget that part. No matter what you do, beta-cell function and mass are going to decline over time, and these people will need escalation of therapies.
It's not a static state, and so it's better to treat them early. And it's not really early; it's appropriate, in my opinion. And use the continuous glucose monitoring so that we can optimize that as fast as possible and maintain that for a longer period of time. Okay, and so think about that part. We have so many diseases that we stage, right? For example, cancer is a classic example. The first staging schema in cancer came in 1929. That was by WHO for cervical cancer. 1929, and the idea behind that was that staging is easier for people to understand that stage 1 to stage 2 is worse, and stage 2 to stage 3 is even worse, right? It tells you about the prognosis. It tells you about what kind of a treatment or the intensity of the treatment that you want to offer to those individuals.
So you're going to hit it pretty hard with the stage 2 and stage 3 than probably stage 1. So I think there are a lot of implications of staging. That's what we do in a lot of different fields, cardiovascular field, like you have heart failure staging, CKD.
Do you call someone with like, "Oh, you have a pre-CKD?" No, we don't. We just say you are stage 1, stage 2, stage 3, right? So similarly, in the type 2 diabetes field, I think we need to think about that staging, and this is what we offer. I'm sure there is room for improvement here, is that don't ignore people who have an elevated glucose level. That's not normal. Okay? So anyone with, I think that 100 is still a little bit higher than what I would like, but at least 100 mg/dL or above, or the time in tight range or time above 140 of more than 5 to 10%, that's not normal.
Okay? Try to have those people utilize the CGM, and Dr. Baron is going to talk more about that, how to utilize that information to improve the health, to prevent the stage 2, which we call pre-diabetes right now. And in pre-diabetes, I think the CGM is the key to optimize the health, making sure that they are not progressing to stage 3 or maintaining that stage 2 as long as possible, right? So I think the CGM is a cornerstone, and again, we understand that we don't have the full evidence for every single thing, but that's where we put in the schema here that for stage 1, it's kind of a more of a research, then you see that in the therapeutic option in pre-diabetes or stage 2, the CGM now comes up, and then at least, in people with existing type 2 diabetes, whether it's insulin therapy or no insulin therapy, CGM comes at the top.
And in my opinion, the ADA Standards of Care algorithm needs to change to put CGM on the top, that for people with type 2 diabetes, we cannot optimize the therapy without understanding their glucose, right? So with that, I think I will end my presentation, but I want to also encourage you to please change this. If you look at tons and tons of research, it sounds like it takes about 17 years for us to change our practice.
Okay? The first professional CGM was approved in 1999. Much better CGMs were around in 2006, and now we are in 2026, again, trying to think about CGM as standard of care. Twenty-six years almost, sorry, 17 years, it's already passed. So I think, think about that part. I think we all have a role to play here to promote health in society.
