2022
Benefits of Continuous Glucose Monitoring
- Insights into effects of food, exercise, illness and medication on real-time diabetes management
- Improved Time in Range (TIR)
- Directional arrows
- Audible alarms for highs and lows
- Approved for children and adults with diabetes
- Connectivity to insulin pumps
- Predictive alerts for highs and lows can automatically adjust insulin delivery rates
- Connectivity with clinicians and family members
- Data can be easily downloaded to the clinician's office and reviewed during a face to face or virtual visit
- Improved A1C
- Reduced absenteeism from work
- Reduced ED Visits
- Reduction in Hypoglycemia
- Reduction in long and short-term DM related complications
Tricks to Successful Initiation of CGM in Primary Care
Role of the Clinician
- Make it simple!
- Consider putting the first sensor on in the office for the patient. Subsequent sensors can be placed by the patient with guidance from MA
- Explain how the CGM may benefit patients' diabetes control
- More time in prescribed range
- Reduced incidence of hypoglycemia
- Improved glycemic variability
- Access to data while sleeping
- Improve A1C
- Reduce risk of hospitalizations
- Improved rates of work absenteeism
Role of the Patient
- Confidence in applying the sensor appropriately
- Scan frequently
- Minimize gaps in sensor wear
- Contact Customer Service if sensors fail or fall off
- Bring data to each visit
- Understand glycemic patterns related to food, sleep, exercise, travel, etc.
CGM Comparison
| Dexcom G6® | Guardian 3® | Libre 14-day® | Libre 2® | Libre 3® | Eversense® | |
| Type of CGM | rtCGM | rtCGM | isCGM | isCGM | rtCGM | rtCGM |
| Days of Sensor Wear | 10 | 7 | 14 | 14 | 14 | Up to 180 |
| Warmup Time | 2 hours | 2 hours | 1 hour | 1 hour | 1 hour | 24 hours |
| Fingerstick calibration required? | No | Yes – minimum of twice daily | No | No | No | Yes – 24 hours after insertion 4 calibrations 2-12 hours apart, then twice daily 10-14 hours apart |
| Alarms | Yes | Yes | No | Yes | Yes | Yes |
| Integrations with Pump | Yes – Tandem t:slim X2 and OmniPod5 | Yes and No; The Guardian 3 is part of the Medtronic 670G/770G hybrid closed-loop insulin pump system. The Guardian Connect is a standalone CGM that does not connect to any pump. | No | No, but is compatible with Bigfoot smart pen cap | No | No |
| Smartphone Integration | Android, iOs, Apple Watch | Android, iOs | Android, iOs | Android, iOs | iOs (Android pending at time of writing) | Android, iOs, Apple Watch |
| Data sharing (only available if using app) | Up to 10 people with Dexcom Follow app (Apple, Google) | Up to 4 people with CareLink™ Connect web app (Apple, Google) | Up to 20 people with LibreLinkup app (Apple, Google) | Up to 20 people with LibreLinkup app (Apple, Google) | Up to 20 people with LibreLinkup app (Apple, Google) | Up to 5 people with Eversense Now app |
| Separate Receiver Available | Yes | No | Yes | Yes | Not at time of writing | No |
| Water Resistance (SENSOR ONLY) | 8 feet for up to 24 hours | 7.5 feet for 10 minutes | 3 feet for 30 minutes | 3 feet for 30 minutes | 3 feet for 30 minutes | 1 meter (~3 feet) for 30 minutes |
| Interferences | Hydroxyurea – may falsely elevate sensor readings) | Tylenol – may falsely elevate sensor readings) | Vitamin C – may falsely elevate sensor readings Aspirin – may falsely lower sensor readings |
Vitamin C >500mg/day – may falsely elevate sensor readings | Vitamin C >500mg/day – may falsely elevate sensor readings | Tetracyclines – may falsely lower sensor readings |
Reference:
Grunberger G, Sherr J, Allende M, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract. 2021 Jun;27(6):505-537.