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Better education, preparation can optimize patient use of CGM

SAN FRANCISCO — Several potential barriers can impede the regular use of continuous glucose monitoring for patients with diabetes, and providers must confront issues of cost, insurance and burdensome paperwork “like preparing them for a trip to the DMV,” according to a speaker here.

Rebecca L. Longo

CGM use has steadily risen over time, as more devices are FDA approved and the technology improves, Rebecca L. Longo, ACNP-BC, MSN, CDE, a nurse practitioner specializing in adult diabetes and medical weight loss at Lahey Hospital and Medical Center in Burlington, Massachusetts, said during a presentation at the American Diabetes Association Scientific Sessions. Regular CGM use is associated with improvements in multiple diabetes outcomes, including a reduction in HbA1c, less hypoglycemia, more time spent in the recommended glucose range and better quality of life metrics, she said. However, recent T1D Exchange data suggest that, over time, CGM use declines, particularly among adolescents.

“Regular use is key,” Longo said during her presentation. “We can prescribe the CGM, but we need to have patients wearing it. When you combine [data] from several of the major trials, 80% adherence seems to be the marker where patients see the optimal benefit.”

Major barriers

Recent T1D Exchange survey data revealed several reasons patients report not wearing CGM, Longo said. Respondents reported reasons ranging from expense, insurance issues, device discomfort, pain, possibility of infection or unfamiliarity with the device.

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Several potential barriers can impede the regular use of continuous glucose monitoring for patients with diabetes, and providers must confront issues of cost, insurance and burdensome paperwork “like preparing them for a trip to the DMV.”
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“When looking at the 14% of patients who discontinued continuous glucose monitoring use, really homing in on these factors is important,” Longo said. “Accuracy, insurance coverage, false alarms … many of these are modifiable factors.”

JDRF survey data revealed similar patient-reported barriers, Longo said, including expense, problems with insertion, persistent alarms (alarm fatigue), accuracy issues and adhesion problems.

“Cost is still No. 1,” Longo said. “They’re expensive. Each individual company has different subscription programs, out-of-pocket policies, and it’s impossible to find out what the actual price of the CGM is.”

Longo noted that for Medicare patients, criteria for covered CGM is strict; patients must perform self-monitored blood glucose monitoring at least four times daily, need at least three insulin injections daily or be on pump therapy, and must be seen by a health care provider every 6 months to assess the patient’s CGM regimen and diabetes treatment plan. In most cases, Longo said, Medicare patients must obtain their CGM from a durable medical equipment company — not a pharmacy.

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