CGM: Continuous Glucose Monitor

Continuous glucose monitors (CGMs) are tools used to measure glucose levels on an ongoing basis. They give information such as trends in your blood sugar and frequency of high and low blood sugar. CGMs help remove the guesswork of what impacts blood sugar. These devices are currently available from manufacturers: Abbott, Dexcom, Eversense, and Medtronic. For people with Type 2 diabetes, especially those on insulin, CGMs can be a major step to consistent glucose monitoring.

What is a CGM and How Does It Work?

A CGM is a small wearable device that tracks your glucose throughout the day and night. The sensor communicates wirelessly with a receiver or smartphone. Some continuous glucose monitors notify you of your high and low glucose readings. Typically, they automatically check your glucose levels at least every 5 minutes. They measure interstitial fluid (ISF), a thin layer of fluid that surrounds the cells of the tissues below your skin, instead of glucose directly from your blood.

A CGM consists of three basic parts:

Receiver (or smartphone): A device where you can check your current glucose level, look at past data, and view your glucose trends and patterns. This may be an app on your smartphone or a separate device.
Sensor: The device that measures glucose. It contains a very thin wire that is inserted under the skin. It’s typically painless to wear and remains in the skin for several days. Users wear them on the stomach and the back of the arms or legs, or according to the manufacturer’s instructions.
Transmitter: Some CGM systems, like Dexcom, also have a small piece that fits onto the sensor. This reusable transmitter sends glucose data wirelessly to your display device.

For example, Abbott’s New FreeStyle Libre 2 system has a painless and water-resistant sensor worn on the back of the upper arm. The sensor measures glucose every minute. The handheld reader included with the system is used to “scan” the sensor. The scan provides current glucose readings, as well as an 8-hour glucose history, trends, the direction your glucose is likely to be heading as well as optional real-time alarms for hypo and hyper events. Declared as the longest-lasting self-applied sensor on the market, one FreeStyle Libre 2 sensor can be worn for up to 14 days.

To learn more about the differences between blood glucose readings and sensor readings, watch the video by FreeStyle Libre system below.

The Benefits of Using a CGM

Pricking your fingers several times per day can feel like a chore. Here are some benefits to using a CGM to prick your fingers less and understand your glucose levels better.

Improved Glycemic Control	Real-time insight into your sugar levels allows you to see how medication, food, exercise, and other activities affect your glucose levels. This means you can make adjustments to your diabetes self-management plan quickly and better convey any trends or concerns to your diabetes care team. Research shows people with Type 2 diabetes who are on multiple daily insulin injection therapies (MDI) and used a CGM lowered their average A1C from 8.5 percent to 7.7 percent. In contrast, those who tracked their glucose using a standard BGM were only able to lower their A1C from 8.5 percent to 8.0 percent. Better management = decreases the risks of complications.
Notifications for High and Low Blood Sugar	CGMs tell you when your glucose is trending too high or low and notify you of high or low blood sugar events. You can set these notifications on your device. Example: You can tell your device to notify you when your glucose levels are reaching 80 mg/dL or lower or spikes to 200 mg/dL or higher. Eversense, a CGM that is implantable and designed for long-term use, sends alerts before you experience a high or low glucose event. Eversense’s alerts can be visual, auditory, and on-body vibe alerts, even during sleep.
Smartphone Capability	Some CGMs have apps available to both iPhone and Android users that function through Bluetooth capability. The FreeStyle LibreLink, allows wearers to get real-time glucose information to their iPhones. The app provides insight into glucose trends and patterns, current glucose readings, and entry for food, insulin use, exercise, and other things that impact glucose numbers. It’s compatible with the iPhone 7 or later running iOS 11 and later. Eversense’s and Dexcom’s respective mobile apps allow you to invite up to 5 friends and family members to view your glucose data.
Diabetes Data Management Software	Need to print the data from your device for your next doctor’s appointment? You’re in luck, as some CGM companies have diabetes data management software where you can view and print standardized reports about your glucose history. The Dexcom CLARITY app lets you stay one step ahead by providing weekly notifications of trends and statistics about your glucose numbers. Their standardized reporting feature shows the big picture of your diabetes management. Finally, Dexcom’s CLARITY app users can compare glucose data to evaluate improvement or problem areas over time. The FreeStyle LibreView app gives healthcare professionals and patients clear, easy-to-understand reports to help you make informed decisions about your health. You and your healthcare provider can access these reports anytime, anywhere.

Usage Tips

Continuous glucose monitors are meant to stick to your skin. If the adhesive is coming off, follow the manufacturer’s instructions on how to replace it. You can also ask the manufacturer to purchase adhesive wipes to ensure the long-lasting wear of your device. Avoid placing your CGM at spots where your body naturally bends or where clothing might cause irritation.

How Do I Get a CGM?

CGMs require a prescription. Talk to your doctor about your device options and decide together which might be best for you. Check what brands are covered under your insurance plan (including patients on Medicaid and Medicare). For example, Dexcom’s CGMs are covered by Medicare. Abbott’s FreesStyle Libre is also covered by Medicare for those who qualify. To receive a CGM under Medicare or Medicaid, please contact your local state health exchange to check your eligibility.

Check to see if your preferred CGM brand offers a complimentary prescription retrieval service. FreeStyle Libre’s prescription retrieval service informs your healthcare professional about the FreeStyle Libre 14-day system. They request a prescription directly from your healthcare provider and notify you when your prescription has been sent to your pharmacy.

Some brands also offer complimentary trial periods for new users. Individuals interested in seeing if they qualify to try a FreeStyle Libre can look into the MyFreeStyle Program. The MyFreeStyle Program allows eligible people to try either the FreeStyle Libre 14 Day System or the FreeStyle Libre 2 system. After your eligibility is determined, you’d request a prescription from your healthcare provider and get guided support from 14 days of emails tailored to your personal journey.

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CGM: Continuous Glucose Monitor