Patient Selection for CGMs in Diabetes

Diana Isaacs, PharmD, BCPS, BCACP, BC-ADM, CDCES: When we think about patient factors to consider for CGM [continuous glucose monitor] use, the patients’ preferences are always my top concern. I want patients to have choices and realize what their options are. We have 4 options on the market, and I want them to understand some of the differences, like alarm capabilities. Some have predictive alerts, so you can predict hypoglycemia in the next 20 minutes. Others don’t and have simpler alerts for highs and lows. Some have the option to turn all alerts off. Others don’t have that option. Some are implantable; some aren’t. The point is that people need to understand the differences so they can make an informed choice about what’s going to be the best option for them. Another example is calibration. Some require fingersticks, and some don’t. You want people to know and understand those things and see what will work best for them.

It’s an interesting question. Is there a subset of patients for whom we wouldn’t recommend CGM? I come back to choice. I had a patient earlier this week who has type 1 diabetes and has been checking with fingersticks 4 times a day and is doing great. He’s reaching his A1C [glycated hemoglobin] targets. He’s doing well. He said he doesn’t want to wear a CGM. He’s concerned that he might feel overwhelmed by the data. He feels that what he’s doing is working very well for him. I respect that choice. In the future, if he’s not meeting his treatment targets, I may try to encourage it more and encourage him to try it, but he’s doing well now. It’s not something we have to force everyone to do.

That being said, I find that with most people, even if they’re reluctant to start it—maybe they don’t want to wear something on their body or they don’t like this idea of all the data—once they try it out, they usually realize, “This was a lot smaller than I thought, and I don’t have to look at the data all the time. I can look only when I want to.” Many people do very well with it.

In terms of providing education when recommending CGM, there are a lot of websites I utilize. I like to provide initial education about the different options in a very objective way, and then I refer to websites like diabeteswise.org, which is a great site. It’s a nonindustry-funded site that objectively goes through the options and asks people questions about what’s important to them so that they can figure out what might be the best technology for them. I also recommend websites like diatribe.org, which is up to date with cutting-edge technology. If there’s a new CGM innovation, we know it will be the first to report on that. I like to send patients to those sites to do a little additional reading for follow-up before they make a decision.

Transcript Edited for Clarity