Candidate selection characteristics include a variety of considerations from physical to general readiness.
From the Personal Continuous Glucose Monitoring Implementation Playbook from ADCES and AphA. Contributors include: Patricia L. Scalzo, MSN, NP, RN, CDCES, Kelly A. Brock, PharmD, RPh and Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES, FADCES. This effort was supported by Dexcom & Abbott.
The American Diabetes Association makes the following recommendation in its 2020 Standards of Medical Care in Diabetes16: “Use of technology should be individualized based on a patient’s needs, desires, skill level, and availability of devices.” By offering a personal CGM program, providers can assess a patient’s needs, desires, and skill level and help them identify a CGM device that will work for them. The American Diabetes Association goes on to say that “Nonprofit websites can offer advice for providers and patients to determine the suitability of various options.”
An example of a valuable not-for-profit website that can help both providers and people with diabetes make decisions as to the initial choice of device is DiabetesWise from Stanford University, funded by The Leona M. and Harry B. Helmsley Charitable Trust
The four criteria set down by CMS17, all of which must be met for coverage, include that the patient must:
To meet the criteria, the system must be classified as a therapeutic CGM. That means users can make treatment decisions using the device. Most commercial payers have coverage for CGM. Eligibility may vary and providers can assist patients in identifying the criteria and help them navigate approval processes.
In the American Journal of Managed Care’s Evidence Based Diabetes Management, 201918, Kompala and Neinstein discuss that one study looked at long-term cost-effectiveness for CGM use in people with type 2 diabetes based on HbA1c reduction, projecting decreased rates of diabetes-associated complications.“ Although we anticipate that HbA1c reduction through lifestyle changes by CGM users could prevent the addition of costly new medications or dose intensification of existing treatments, more study is needed to test this. This matters: Studies looking at HbA1c compared with healthcare costs have found significant impacts. In one case, a 1% decrease in A1C was associated with $685 to $950 per year lower total healthcare costs, and in another, a 1% increase in HbA1c was associated with a 7% increase in healthcare costs over the next 3 years.”
Is your patient with diabetes ready to utilize continuous glucose monitoring technology? Welsh notes, in his June 2018 Diabetes Technology & Therapeutics19 article, “Role of Continuous Glucose Monitoring in Insulin-Requiring Patients with Diabetes,” that it is important to set realistic expectations of CGM use to help avoid frustrations and disappointment. “CGM use should not be imposed on those who are unwilling to use it consistently or incapable of using it beneficially.” Comprehensive training on the device is important, both initially and ongoing, and will lead to the long-term success of the individual with the CGM20. One strategy to assist the person with diabetes who is feeling uncertain if personal CGM is right for them would be to offer a short-term trial with professional CGM.21
This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your diabetes care and education specialist or healthcare provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. To find a diabetes care and education specialist near you, visit diabeteseducator.org/Find.
ADCES and danatech curate product specifics and periodically review them for accuracy and relevance. As a result, the information may or may not be the most recent. We recommend visiting the manufacturer's website for the latest details if you have any questions.