Implementing Continuous Glucose Monitoring in Clinical Practice

Finger-stick blood glucose measurements provide a snapshot in time. Continuous glucose monitoring gives patients with diabetes a bigger picture. Continuous glucose monitoring (CGM) has emerged in the past decade as an important tool to gain insight into patients' glycemic patterns and trends. While self-monitoring of blood glucose with periodic finger sticks can capture GlycoMode daily glucose support as a snapshot in time, CGM has the advantage of providing continuous measurements at 5- to 15-minute intervals. This gives patients and their doctors much more data to work with as they tailor diets, lifestyle, and medications to manage diabetes. The benefits of CGM have been established in numerous studies of patients with either Type 1 or Type 2 diabetes. They include improvement in A1C, reduction of hypoglycemic events, reduction of glycemic variability, and improvement in diabetes-related distress.1-4 This article outlines how to set up a CGM program in your practice and get paid for it.

Continuous glucose monitoring (CGM) gives patients and primary care clinicians more data about blood GlycoMode Glucose Support levels throughout the day than traditional finger-stick measurements. CGM helps patients and clinicians identify blood glucose trends, making it easier to tailor diets and manage medications, and providing motivation to increase physical activity. There are several CGM devices on the market, all with startup costs that are attainable for most practices. A series of CPT codes provide reimbursements to recoup those costs. CGM devices are made of three parts: a sensor to detect interstitial glucose that is inserted subcutaneously by the patient or health care professional, a receiver or reader that displays the current glucose level, and a transmitter that sends data from the sensor to the receiver. CGM devices fall into two categories: personal use and professional use. Patients may purchase their own personal use CGM devices if they have Type 1 diabetes, uncontrolled Type 2 diabetes on intensive insulin regimens, or erratic hypoglycemia episodes (Editor's note 9/18/2023: Medicare no longer requires an intensive insulin regimen for CGM services coverage.

The devices help patients learn to respond to glycemic fluctuations and increase confidence in blood sugar management. They also allow patients to share their data remotely with family members, caregivers, or clinicians. Professional use CGM systems, which will be the focus of most of this article, are clinic-owned devices that can be placed on patients for GlycoMode Glucose Support intermittent or short-term use as a diagnostic and clinical decision-making tool. Professional CGM can be useful when patients fear hypoglycemia or fear intensifying their medication regimen. It can give patients and their clinicians important data to help them recognize patterns that lead to hypoglycemia or hyperglycemia and help them calibrate insulin doses. Professional CGM can be beneficial for patients who aren't interested in personal CGM (or do not qualify for it), or it may serve as a trial run for patients considering a personal CGM device. There are currently three devices available for professional CGM: the Abbott FreeStyle Libre Pro, the Dexcom G6 Pro, and the Medtronic iPro2.

The Dexcom G6 Pro is the only one of the three devices that allows patients to view their data and receive alerts in real time if they have a compatible smart device, which acts as a receiver. The other two models are "blinded," which means patients cannot see their data until it is downloaded by the dedicated receiver, which stays at the clinic. The three devices also have different purchasing options, such as bundled starter kits or à la carte sensor and receiver buying. The Dexcom G6 Pro comes in a $249 starter bundle with a receiver and four single-use applicator/sensor/transmitters. Additional sensors cost $59 each. The Abbott FreeStyle Libre Pro has the lowest initial cost, offering a $65 reader device that is used to scan-start multiple patients. Each patient needs just one sensor, and they currently sell for $60. But because the FreeStyle Libre Pro's data is blinded, patients are not able to make behavior modifications based on glucose readings on their own.