Expect Patients to Use CGM Devices Earlier in Diabetes

Top Takeaways

• Guidelines support earlier and broader use of continuous glucose monitoring (CGM) in diabetes care.
• Be prepared to navigate varying CGM payer coverage requirements and product changes.
• Ensure that patients receive pharmacist counseling to learn about proper use and factors that can impact results.

You’ll start to see earlier use of continuous glucose monitoring (CGM) devices in patients with diabetes.

Am Diabetes Assoc (ADA) guidelines now recommend CGM at diagnosis or anytime after for patients on insulin or other meds that can cause low blood sugar (glipizide, etc)...or whenever CGM can help with management.

That’s because early initiation improves blood sugar control (A1c) and limits episodes of dangerously low blood sugar (hypoglycemia).

But keep in mind that payer policies don’t always align with guidelines. And anticipate that insurers may still require insulin use...or history of severe hypoglycemia...for CGM coverage.

Pull in the pharmacist to help patients find the best CGM device to meet their needs...and be familiar with Rx CGMs and product changes.

For example, Dexcom G6 will no longer be manufactured after July 1, 2026. Help patients transition to an alternative, such as a Dexcom G7 CGM.

Keep in mind the G7 sensor can be worn for 10 days...while the G7 15-day sensor lasts 15 days like its name implies.

Libre 2 Plus or Libre 3 Plus sensors also last 15 days. Libre 3 Plus is smaller...and has a bigger Bluetooth range.

But be aware, some Libre 3 Plus sensors are part of a recent class I recall...due to incorrectly low readings. Check your inventory...and advise affected patients to request a replacement from the manufacturer.

Eversense 365 is another Rx CGM option. The sensor lasts for 1 year...but must be inserted by a trained healthcare provider.

OTC CGMs (Lingo, Stelo) are also available...but they’ll usually be saved for patients who aren’t on insulin or prone to hypoglycemia. These CGMs lack alarms for low or high blood sugar (glucose)...and measure glucose in a narrower range.

For instance, Stelo only reads glucose from 70-250 mg/dL and Lingo reads 55-200 mg/dL...while most Rx CGM devices read from 40-400 mg/dL.

Ensure that CGM users get pharmacist counseling about proper use. For example, they should wash the sensor site with soap, dry, clean with an alcohol swab, and let dry before application. If sensors don’t stay on, they can try a product to improve adhesion (Skin Tac, Tegaderm, etc).

Patients should also be aware of factors that may impact results. For instance, sleeping on the sensor may cause false “compression lows.” And taking higher doses of acetaminophen or vitamin C may lead to falsely elevated readings with certain CGMs.

Dig into our resource, Continuous Glucose Monitoring, for product comparisons and troubleshooting tips.

• FAQ: Continuous Glucose Monitoring