Continuous Glucose Monitoring - Not Just for Type 1 Diabetes Anymore

More than 1·31 billion people could be living with diabetes by 2050 worldwide, according to recent estimates¹. The increase in prevalence (up from 529 million in 2021) is expected to be driven by increases in type 2 diabetes, which in turn will be caused by a rise in the prevalence of obesity and by demographic shifts.

Already, an estimated 90% to 95% of people with diabetes have type 2². Yet only a small percentage of them manage their diabetes with a relatively new technology – continuous glucose monitoring, or CGM. But that may change.

CGMs continually monitor blood glucose (blood sugar), giving real-time updates through a device that is attached to the body.³ CGMs are recommended for several reasons because they:

Help avoid or delay serious, short- and long-term diabetes complications.
Potentially save money through improved diabetes management and fewer events, like hypoglycemia (low blood glucose) leading to emergencies.
Offer people with diabetes and their healthcare team more details about glucose levels than traditional blood glucose meters, giving them the opportunity to analyze the data more precisely than ever before.
Provide biofeedback in real time, which allows people with diabetes to modify their dietary pattern or insulin dose based on trends, as directed by their healthcare provider. This may reduce the risk of hypoglycemia and hyperglycemia (high blood glucose).

Continous glucose monitoring 2

The first device for reading blood glucose levels continuously was a professional CGM approved by the U. S. Food and Drug Administration in June 1999.⁴ Today, CGM is an established standard of care for people with type 1 diabetes and is used by approximately 40% to 50% of this population⁵

But it is only in the last few years that doctors have considered CGM a viable option for patients with type 2 diabetes. The tide began to turn in 2017, with the publication of the Dexcom-funded DIAMOND randomized, controlled trial studying the effect of real-time CGM use for people with type 2 diabetes who were on an intensive insulin regimen.⁶ Their A1C levels dropped by 0.3% more than those using standard blood glucose strips over six months — a small but statistically significant change.

Since then, other studies have demonstrated the effectiveness of CGM for people with type 2 diabetes. For example, in 2021, a randomized clinical trial including 175 adults with poorly controlled type 2 diabetes resulted in a significantly greater decrease in HbA1c level over eight months with continuous glucose monitoring than with blood glucose meter monitoring.⁷

What About the Future?

In the United States, CGM received a boost when the Centers for Medicare & Medicaid Services expanded coverage for services provided on or after April 16, 2023.⁸ CGM services are now covered for all patients with diabetes who are treated with insulin or who have hypoglycemia. (Previously, CMS required beneficiaries to be insulin-treated with multiple daily administrations of insulin or a continuous subcutaneous insulin infusion pump.) The coverage change includes type 1, type 2, and gestational diabetes.

While that is good news for people with type 2 diabetes, inequity may play a large role in who will ultimately have access to continuous glucose monitoring.

Studies show that poorer, older, Black and Brown Americans and people on Medicaid have less access to CGMs than their counterparts.⁹ The American Diabetes Association says that people with diabetes have the right to access the latest technologies. Federal and state government officials can and should take steps to drive improved and more uniform coverage policies for diabetes technology and supplies within.

Diabetes will be a defining disease of this century. How the health community deals with it in the next two decades will shape population health and life expectancy for the next 80 years.

Diabetes will be a defining disease of this century. How the health community deals with it in the next two decades will shape population health and life expectancy for the next 80 years. The world has failed to understand the social nature of diabetes and underestimated the true scale and threat the disease poses.

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