Integrating Continuous Glucose Monitoring Systems into Clinical Practice

Davida Kruger, NP: What is interesting is the research in the past, 5 to 7 years [ago], research has been done in the children, the adults, the teens, the older individuals. I sort of get testy when we talk about older individuals because I’m not sure how to define that. If it’s old, it has to be older than me. But we’ve looked at all age groups. We’ve looked at all learning abilities. We’ve looked at different ethnicities to see how CGM [continuous glucose monitoring] improves lives and how it can be utilized in practice. We’ve done a great job to say that this can be applied to all people with diabetes and certainly in the world of type 2 diabetes that that outcome would benefit. For now, we have only coverage [for] multiple daily injections. It looks like we might, soon, get coverage for just basal insulin and then we’ll have to go from there. The other thing is it’s becoming more and more affordable. If, and you know I’d never want to spend anyone else’s money, but if people wanted to be able to purchase, there are ways to do that as well.

Margo B. Minissian, PhD, ACNP: The more that we can submit to insurance companies. You know we had the same thing with coronary calcium scoring, for example, and insurance companies not wanting to initially pay for that. Other types—the ambulatory blood pressure monitoring wasn’t always covered either. Those became out of pocket expenses that add up quickly, especially with the struggles that so many people are facing, especially those who have chronic disease management that us submitting information to these insurance companies helps to elevate that bar for more coverage. For more coverage for most, which is what should be happening.

Davida Kruger, NP: I agree 100%. It’s all about you know finger sticks, when they first came out, I jokingly say but seriously mean, I remember thinking, “Oh, who gets this?” And of course, everyone with diabetes should be doing either blood glucose monitoring or continuous glucose monitoring. I am now at the point where I feel like continuous glucose monitoring should be a right not a privilege and we should be offering to more and more people with diabetes. Think about that, if you had diabetes, for me, the greatest risk for being [able] to go to sleep at night would be, “Oh my gosh, what if I have a hypoglycemic event and I miss it and something happens?” If I wore a continuous glucose monitoring and it alarmed when it started getting low, then I would be able to. The other thing is that, as a healthcare provider, there’s a great way to learn how to interpret the data. It’s not complicated. It can be put on your computer and guess what, you can bill for those interpretations. We give too much away. Not that we shouldn’t be providing the highest level of care but because most patients who have type 2 diabetes are in the primary care world, we need to extend that into the primary care world. How do you use continuous glucose monitoring? How does it enhance your practice and your relationship with your patient? Let me tell you, you can bill for it and insurance companies do pay for the interpretation and, if you use a professional, for the placement of CGM.

Margo B. Minissian, PhD, ACNP: Yes, absolutely. And remember, we’re fighting a war on health equity here. When you think about those who don’t have access to CGM, it tends to be those individuals that would fall within these disparities. We need to stop this. This is unacceptable, especially when we have such robust data that we can significantly improve their lives. This really needs to happen and we shouldn’t, as providers, tolerate it. Or patients either, tolerate it any longer with what we currently know.

Davida Kruger, NP: I feel like too, the other end of the spectrum is our Medicare patients who do go into the donut hole, and they’ve been doing so well in the therapies we provide. Then we can’t get medication for them for a particular period of time and that’s heartbreaking.

Margo B. Minissian, PhD, ACNP: It is. It really is. I have a husband and wife that share medications and they will split up their meds because one of them is in a donut hole—it’s just…it’s so heartbreaking. This is when working with a pharmacist closely, is vitally important and another key takeaway, I feel, that is if you are working with a diabetes team then a pharmacist should be included in that care team and that there’s some great data demonstrating cost reduction for the institution when the pharmacist is included. Many times, they can help us combat these different barriers and find alternate ways of funding for essential medications.

Davida Kruger, NP: You’re absolutely right. That’s the one person we’re seeing in addition. We’ve always had the educator. We’ve always had someone in nutrition, but what I’m seeing more and more is the addition of the pharmacist for exactly the reasons you’ve described and also they can work closer with the patient too if they’re having drug-to-drug interactions. Why are you stopping a medication? They can watch for refills and making sure that the patient is in fact refilling their medication. Those are good points. Really good points.

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Transcript edited for clarity.