The Role Of Healthcare Professionals
From the healthcare professionals perspective, CGM is often a cost burden and inaccessible for people who are underinsured, have lapses in health plans or new deductibles, or cant get CGM covered due to not yet meeting insurance requirements, says diabetes care and education specialist in Ohio.
Its more accessible now, though.
Blanchette says commercial insurers have loosened requirements, such as the 60 to 90 days of blood sugar logs they once mandated to approve a CGM. She says Medicaid in her state of Ohio eliminated any logbook requirement. But Medicaid still only covers CGM for people requiring insulin, taking at least 3 injections per day, or using insulin pump therapy.
Blanchette, who also lives with T1D, says she faces CGM affordability struggles herself too. That helps inform how she talks with people about this technology.
I struggled to pay for very costly CGMs over the past few years. I maxed out my flex spending and found other ways to pay for the high cost, like charging my credit card until I could pay, she says.
CGM is trying to move towards the pharmacy model, which will save people a lot on monthly payments. For people with high costs through durable medical equipment suppliers, I encourage them to look into changing over to the pharmacy. This is successful and much cheaper in some cases but definitely not in all situations.
How Does A Continuous Glucose Monitor Work
A CGM works through a tiny sensor inserted under your skin, usually on your belly or arm. The sensor measures your interstitial glucose level, which is the glucose found in the fluid between the cells. The sensor tests glucose every few minutes. A transmitter wirelessly sends the information to a monitor.
The monitor may be part of an insulin pump or a separate device, which you might carry in a pocket or purse. Some CGMs send information directly to a smartphone or tablet. Several models are available and are listed in the American Diabetes Associations product guide.
Getting Free Flash Sensors And Cgm Sensors
If you get a Freestyle Libre or a CGM on the NHS, you should also get the other things you need like sensors and replacement parts.
Its also worth knowing that sensors only work for individual products, so sensors for a Freestyle Libre wont work for a Freestyle Libre 2 or a CGM.
Using a Freestyle Libre helps me prevent hypos and its much more sociable because when I’m out, I dont have to find somewhere convenient and clean to do a finger prick check. Im lucky I can afford to self-fund.
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Who Can Use A Cgm
Most people who use CGMs have type 1 diabetes. Research is underway to learn how CGMs might help people with type 2 diabetes.
CGMs are approved for use by adults and children with a doctors prescription. Some models may be used for children as young as age 2. Your doctor may recommend a CGM if you or your child:
- are on intensive insulin therapy, also called tight blood sugar control
- have hypoglycemia unawareness
- often have high or low blood glucose
Your doctor may suggest using a CGM system all the time or only for a few days to help adjust your diabetes care plan.
How Cgms Change Life With Diabetes
The idea here is empowerment, as these devices provide some serious medical and lifestyle benefits.
First off, you can literally see in real time the effects of food and exercise on your blood glucose levels, and catch cases of hyperglycemia and hypoglycemia as they happen, avoiding the potentially dangerous consequences. This is a huge advantage over historic static blood glucose monitoring, which only provides a single glucose reading at a time.
Theres also the convenience factor. CGMs can essentially eliminate the need for regular fingerstick tests, the long-standing only way to check blood sugar levels. Though fingersticks are sometimes needed to calibrate CGM systems and can still serve as a backup data source, they are no longer a constant, nagging, unpleasant to-do.
Furthermore, studies (
here ) show that CGMs can help increase the users time-in-range , the overall percentage of time spent in a healthy glucose range. TIR is quickly becoming the new gold standard measure of positive diabetes outcomes.
CGMs can be especially beneficial for active children , for ensuring safety during physical activity and during nighttime glucose fluctuations.
Its also a potentially life-saving tool for people with diabetes who experience hypoglycemia unawareness, alerting them to impending low blood sugars when their own bodies fail to recognize the warning signs.
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Why Medicare Will Cover The Medtronic Cgm Now
Up until now, Medtronic has been the only CGM company without Medicare coverage.
The other CGM products available Dexcom G5 and G6, Abbott FreeStyle Libre 2, and the implantable Eversense CGM from Senseonics and Ascensia have been covered for years. But Medtronic is the only company that did not get a non-adjunctive designation , which wouldve allowed the CGM to be used for insulin dosing and treatment decisions without a need for confirmatory fingersticks.
That so-called dosing claim was a new category created by the Food and Drug Administration , its first attempt to distinguish the different levels of CGM technology that existed at that time in 2017. The Dexcom G5 was the first to obtain that status and be known as a therapeutic CGM, followed by the Abbott FreeStyle Libre and then Eversense 90-day implantable CGM.
To date, Medtronics Guardian CGM remains the only one that requires fingerstick calibrations and doesnt have Medicare coverage.
But CMS is now changing that, lumping Medtronics device into the same category as the non-adjunctive devices so that they are all covered by Medicare.
Importantly, the new Medicare policy does not include Medtronics stand-alone Guardian Connect CGM system. Instead, it only allows for Medicare coverage of the Medtronic CGM when it is combined with the companys MiniMed insulin pumps.
Is Continuous Glucose Monitoring Worth It
Continuous glucose monitoring systems may not make life with diabetes any easier. But they can definitely improve health, if you can deal with the hassle and expense. So how do you know if such a system is right for you?
As many readers already know, CGMS give a nearly continuous readout of glucose levels in tissue fluid, the wet stuff that oozes out when you have a scrape or a burn. To read these levels, you insert a long-lasting sensor under your skin, a process that feels similar to a needle stick. The sensor is made of material like the filters used in dialysis. It measures glucose levels and radios the results, via a connected transmitting device, to a small receiving device about the size of a pager.
This sounds nice much more information without all the needle sticks. Unfortunately, you still have to do fingertip blood checks 24 times a day to keep the monitor calibrated. And the information you get from the meter is only valuable if you know how to use it.
Originally, CGMS was for your doctor. You got a continuous 72-hour readout of blood sugar levels, with a nice graph to go with it. If you conscientiously wrote down what you ate, your exercise, and medicines, your doctor would learn a lot about your bodys use of food and insulin. The doc could adjust insulin dosages and other aspects of your care. Then you gave the monitor back.
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Continuous Glucose Monitoring Cost
A continuous glucose monitoring system is designed to offer a continuous readout of the glucose levels in the tissue fluid, and in order for the device to work, you will insert a sensor beneath your skin, similar to that of a needle stick, according to Diabetes Self-Management.
Made of similar filters used in dialysis, this FDA-approved device continuously measures your glucose levels, all while sending the results to a nearby connected device, usually the size of a small piece of paper every five to 15 minutes.
Getting Insurance For Your Cgm Or Freestyle Libre
Like all types of tech, looking after it and things like making sure the batteries are charged is important. Because electronic devices are expensive, you may wonder whether to get insurance to cover it in case you lose or break it. Before taking our separate insurance, its worth seeing if you can have it as a named item on your household insurance. This might be a cheaper and simpler option.
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Comparison Of Current Continuous Glucose Monitors
A continuous glucose monitor or CGM reveals short-term trends in glucose as they happen. You can see the direction your glucose has taken over the last 1, 3, 6, 9, 12, or 24 hours. Upload your data to view reports of averages and trends over periods of up to 90 days.
CGMs are now widespread and widely covered by insurance to benefit both Type 1s and Type 2s. Several manufacturers are getting in on the action, offering a variety of features and costs.
Major players in the field include Dexcom, Medtronic, Freestyle Libre, and Eversense. We discuss the features of each below.
Cgm Vs Blood Glucose Meter
The CGM sensor automatically and continuously tracks glucose levels, using a sensor inserted just below the skin. CGM systems measure glucose in the interstitial fluid the fluid between your cells just under the skin. Since CGM is measuring glucose in a different part of the body, it will not be the same concentration as in the blood.
A blood glucose meter takes a small sample of blood from your fingertip and places it on a test strip thats inserted inside a meter. The meter provides a glucose value based on the amount of glucose in the blood sample at that moment.
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How Does A Flash Glucose Monitor And Cgm Work
Flash glucose monitors and continuous glucose monitors let you check your blood sugar levels without you having to prick your fingers.
You wear a small sensor on your body day and night that reads your blood sugar levels so you can see the information on your mobile, or other device. If someone helps you look after your diabetes, their mobile can be linked up too.
With a CGM and the latest flash glucose monitor , you can also set an alarm to sound if your blood sugar levels go too low or too high.
This can also be set up to sound on someone elses mobile, for example, a parent or carers.
One of the other main benefits of a flash glucose monitor and CGM is being able to review what your blood sugar levels do every minute of the day and night. With the charts and graphs, you can start to see and understand how food, activity, and other things affect your blood sugar levels.
“It’s a real mental health break knowing what your blood sugar levels are doing at any one time.” Matt
Special Features Of A Cgm
CGMs are always on and recording glucose levelswhether youre showering, working, exercising, or sleeping. Many CGMs have special features that work with information from your glucose readings:
- An alarm can sound when your glucose level goes too low or too high.
- You can note your meals, physical activity, and medicines in a CGM device, too, alongside your glucose levels.
- You can download data to a computer or smart device to more easily see your glucose trends.
Some models can send information right away to a second persons smartphoneperhaps a parent, partner, or caregiver. For example, if a childs glucose drops dangerously low overnight, the CGM could be set to wake a parent in the next room.
Currently, one CGM model is approved for treatment decisions, the Dexcom G5 Mobile. That means you can make changes to your diabetes care plan based on CGM results alone. With other models, you must first confirm a CGM reading with a finger-stick blood glucose test before you take insulin or treat hypoglycemia.
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Guardian Connect Smart Cgm
The Guardian Connect CGM monitors your glucose levels day and night and alerts you of highs or lows before they happen. You can set alerts anywhere from 10 to 60 minutes, getting notified exactly when you want. The system includes a small sensor worn up to seven days and a slim, discreet Bluetooth® transmitter. They work together to send precise glucose readings automatically to your phone every five minutes.
Guardian Connect CGM has you covered and looks ahead so you can focus on living your life, instead of watching your glucose levels.
A simple way to better control your diabetes.
The iPro2 Professional CGM system records your glucose levels 24 hours a day for up to six days. Used intermittently, the iPro2 system provides your physician with insights into how the nutrition plan, medication regimen and daily activities affect your glucose levels, enabling them to make more informed decisions regarding your diabetes management.
Some Cgm Sensors Cost Less Without Insurance
If you dont have health insurance, this doesnt always mean you cant access a continuous glucose monitor. While health insurance may make it easier for some people with diabetes to access a CGM at an affordable rate, this isnt always the case.
Even if you have a high deductible healthcare plan , you may find that some continuous glucose monitors like the Freestyle Libre 2 cost less out of pocket without running insurance.
A Freestyle Libre 2 sensor can be purchased without insurance at many pharmacy counters across the United States for typically around $130-140 for two sensorsabout a months worth of supplies. So long as you have a prescription for the product, you should be able to fill it and purchase it for around this price point.
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What The Future Holds For Continuous Glucose Monitoring Technology
Its an exciting time for diabetes tech innovation as CGM functionality continues to evolve and new CGM manufacturers enter the market. There are also further developments and research into the connection between a CGM and insulin pump, and ways to automate the insulin delivery process.
For CGMs, researchers are hoping to develop longer lasting sensors and further smartphone connectivity and features. To learn more, Diabetes Forecast offers a rundown on some next generation diabetes products on the horizon.
If you have any questions about continuous glucose monitoring or blood glucose meter technology, please contact us here.
Average Monthly Cost Of Cgm
When comparing out-of-pocket prices without insurance factored in, CGM systems supplies can range from roughly $160 per month all the way up to $500 per month .
Of course, health insurance may ease the financial burden, but its difficult to assess just how much because health plans and approved benefits vary greatly. High deductible and coinsurance plans require people to put down large amounts of money before their coverage kicks in.
So be sure to check with your insurance plan first to determine what coverage you may have for obtaining a CGM system, and what it may cost to get the supplies you need over time.
Keep in mind, too, that sometimes insurers deny coverage at first and it may require you to self-advocate along with your healthcare professional to demonstrate your medical necessity for getting a CGM.
Below are the basics on pricing.
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Continuous Glucose Monitoring Fact Sheet
Continuous glucose monitoring is a way to check glucose levels throughout the day and night without pricking your finger.
CGM can help you see the effects of insulin and other medicines, food, physical activity, and illness on your glucose levels. It can help you make decisions to keep your glucose levels in a healthy range. It can also help find trends or changes in your glucose levels. You can use this information to make day-to-day decisions about how to manage your diabetes. You can also share this information with your diabetes health professionals to help make decisions about your diabetes management. CGM provides more information than blood glucose monitoring with a finger prick check.
Read more in our fact sheet Continuous glucose monitoring.
Getting The Freestyle Libre App On Your Mobile Phone
To scan your Freestyle Libre 1 or Freestyle Libre 2 sensors from a smart mobile phone, download the the Freestyle LibreLink app from the app store on your phone.
Sharing data with friends and family
You can also share the data from your Freestyle Libre with friends, family or carers via the Libre Linkup app. They will need to download the LibreLinkUp app and create an account. You can then give them access to your data using your own LibreLink app and their email address
If its your first time opening the app, then you may need to set up an account. Once youve done that, hold your phone or device up to the sensor and you should feel it buzz twice. The sensor has been scanned and the app requires 60 minutes to calibrate so youll need to wait that long and then you can use it.
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How Finger Prick Checks Differ To Cgm/flash Readings
A finger prick check tells you what your blood sugar level is at that moment.
With a flash glucose monitor or CGM, whats being measured is the amount of sugar in the fluid surrounding your cells. This is called interstitial fluid. Its not quite as accurate as a finger prick test as it lags behind blood sugar levels by up to 15 minutes. And the difference between the blood sugar and CGM or flash reading is more likely to be greater when youre eating or exercising.
So even if youre offered a flash glucose monitor or CGM by your healthcare team,its important that you still get your diabetes kit on prescription including your blood glucose meter to let you do finger prick checks. “
“I found that pricking my finger up to ten times a day was challenging and sometimes painful so I got the freestyle libre 2 sensor which has helped a huge tonne. Alfie, 15