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.

Fam Pract Manag. 2021 Mar-Apr;28(2):7-14.

Author disclosures: no relevant financial affiliations disclosed.

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 glucose 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.14 This article outlines how to set up a CGM program in your practice and get paid for it.

KEY POINTS

  • Continuous glucose monitoring (CGM) gives patients and primary care clinicians more data about blood glucose 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.

PERSONAL VS. PROFESSIONAL CGM

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. 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.

An in-depth review of personal CGM patient selection and device comparison has been published elsewhere.5 No long-term studies have been performed to determine whether personal use CGM improves clinical outcomes in patients with Type 2 diabetes; however, evidence suggests both personal and professional CGM improve glycemic control by increasing time in range.6,7

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 intermittent or short-term use as a diagnostic and clinical decision-making tool. Profe

ABOUT THE AUTHORS

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Dr. Adkison is a clinical pharmacist and faculty member of the Memorial Family Medicine Residency Program at Memorial Hermann Health System in Sugar Land, Texas. She teaches primary care pharmacotherapy and specializes in diabetes management....

Dr. Chung is associate program director of the Memorial Family Medicine Residency Program.

Author disclosures: no relevant financial affiliations disclosed.

Editor's note:

For additional guidance, see the AAFP TIPS resource on CGM (free to AAFP members), available April 16.

 

References

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1. Vigersky R, Shrivastav M. Role of continuous glucose monitoring for Type 2 in diabetes management and research. J Diabetes Complications. 2017;31(1):280–287....

2. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with Type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA. 2017;317(4):371–378.

3. Beck RW, Riddlesworth T, Ruedy K, et al. Continuous glucose monitoring versus usual care in patients with Type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med. 2017;167(6):365–374.

4. Ida S, Kaneko R, Murata K. Utility of real-time and retrospective continuous glucose monitoring in patients with Type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. J Diabetes Res. eCollection 2019;4684815.

5. Longo R, Sperling S. Personal versus professional continuous glucose monitoring: when to use which on whom. Diabetes Spectr. 2019;32(3):183–193.

6. Robertson SL, Shaughnessy AF, Slawson DC. Continuous glucose monitoring in Type 2 diabetes is not ready for widespread adoption. Am Fam Physician. 2020;101(11):646.

7. Maiorino MI, Signoriello S, Maio A, et al. Effects of continuous glucose monitoring on metrics of glycemic control in diabetes: a systematic review with meta-analysis of randomized controlled trials. Diabetes Care. 2020;43(5):1146–1156.

8. Allen NA, Fain JA, Braun B, Chipkin SR. Continuous glucose monitoring counseling improves physical activity behaviors of individuals with Type 2 diabetes: a randomized clinical trial. Diabetes Res Clin Pract. 2008;80(3):371–379.

9. Sierra JA, Shah M, Gill MS, et al. Clinical and economic benefits of professional CGM among people with Type 2 diabetes in the United States: analysis of claims and lab data. J Med Econ. 2018;21(3):225–230.

10. Diabetes Technology: Standards of Medical Care in Diabetes - 2021. American Diabetes Association. Diabetes Care. 2021;44(Suppl 1):S85–S99.

11. Welsh JB, Gao P, Derdzinski M, et al. Accuracy, utilization, and effectiveness comparisons of different continuous glucose monitoring systems. Diabetes Technol Ther. 2019;21(3):128–132.

12. Kruger DF, Edelman SV, Hinnen DA, Parkin CG. Reference guide for integrating continuous glucose monitoring into clinical practice. Diabetes Educ. 2019;45(1 suppl):3S–20S.

13. Hammond P. Continuous glucose monitoring: the clinical picture. How to interpret and use the data. Practical Diabetes. 2012;29(9):364–368.

 
 

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