Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

Professional Guidelines

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National Institute for Health and Care Excellence (NICE) Medtech Innovation Briefing for Dexcom G6 Real-Time CGM – November 2020


Key Takeaway: The intended place in therapy is as an alternative to routine blood glucose monitoring in people (over 2 years old), including pregnant women, with type 1 or type 2 diabetes, who use multiple daily insulin injections or use insulin pumps and are self-managing their diabetes.  Dexcom G6 could reduce costs and would benefit the healthcare system by improving long-term outcomes, reducing the need for intensive treatment and, in the short term, reducing severe hypoglycaemic events leading to hospital admissions. Remote care may reduce the need for hospital visits.

Diabetes Technology: Standards of Medical Care in Diabetes – 2020

Source: Diabetes Care

Key Takeaway: The ADA Standards of Medical Care in Diabetes provides the most authoritative and current guidelines for diabetes care. The recommendations are intended to provide clinicians, patients, researchers and payers with the components of diabetes care, general treatment goals, and tools to evaluate the quality of care. Following are ADA recommendations regarding CGM:

American Diabetes Association

rtCGM should be used continuously for maximal benefit. 

isCGM should be scanned frequently throughout the day (minimum of once every 8 hours)

CGM and T1D

  • Real-time CGM (rtCGM) and intermittently scanned CGM (isCGM) are useful to lower A1C and/or reduce hypoglycemia in adults who are not meeting glycemic targets, have hypoglycemia episodes, and/or unawareness (RT-CGM (A); IS-CGM (C))
  • rtCGM may be used to improve A1C levels and neonatal outcomes in pregnant women (A)
  • Should be considered in all children and adolescents to improve glucose control regardless of insulin delivery method (B)

CGM and T2D

  • Useful tool, when used in conjunction with insulin therapy, to lower A1C and/or reduce hypoglycemia in adults with T2D who are not meeting glycemic targets (B)

Level of Clinical Evidence: A = Clear evidence from well-conducted, generalizable randomized controlled trials that are adequately powered; B = Supportive evidence from well-conducted cohort studies; C = Supportive evidence from poorly controlled or uncontrolled studies

Continuous Glucose Monitoring: A Consensus Conference of the American Association of Clinical Endocrinologists and American College of Endocrinology

Source: American Association of Clinical Endocrinologists

Conclusion: CGM improves glycemic control, reduces hypoglycemia, and may reduce overall costs of diabetes management. Expanding CGM coverage and utilization is likely to improve the health outcomes of people with diabetes.