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  2. Continuous glucose...
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Practice Therapeutics

Continuous glucose monitoring

BMJ 2023 ; 380 doi: https://doi.org/10.1136/bmj-2022-072420 (Published 03 March 2023) Cite this as: BMJ 2023;380:e072420
  1. Dana M Lewis , independent researcher 1 ,
  2. Tamara K Oser , associate professor 2 ,
  3. Benjamin J Wheeler , paediatric endocrinologist/head of child health 3
  1. 1 #OpenAPS, Seattle, WA, USA
  2. 2 Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
  3. 3 Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, New Zealand
  1. Correspondence to DM Lewis Dana{at}OpenAPS.org

What you need to know

  • Continuous glucose monitoring (CGM) is the preferred glucose monitoring method in most recent guidelines (ADA/EASD/ISPAD) for people with insulin-requiring diabetes, but it is also suitable for all people with diabetes

  • Accuracy of CGM is close to that of finger stick blood glucose testing

  • Often, conscious or unconscious bias and concerns about technical or data literacy prevent providers from discussing CGM/intermittently scanned CGM with people with diabetes

  • CGM is costly, which leads to inequity in terms of patient access and research around the topic

A person in their 60s with type 2 diabetes presents to their primary care provider for a diabetes follow-up visit. They express frustration with an above-target glycated haemoglobin (HbA 1c ), their current glucose management, and the associated burden, which includes finger stick blood glucose testing and multiple daily injections of insulin. They ask if any additional tools are available to help them manage their glucose levels more effectively on a day-to-day basis.

Continuous glucose monitoring (CGM) can be an area of uncertainty for many primary care doctors, which can lead to lower prescribing rates. In this paper, we review the available evidence and guidance on CGM. Currently, this is mostly relevant to people with diabetes in higher resource settings, as use of diabetes devices is lower in resource limited settings, and these populations are poorly represented in previous CGM studies. However, in writing this article, we also advocate for increased worldwide effort to improve access to CGM for these populations, and to improve research in the field.

What is CGM?

Continuous glucose monitors are devices that offer an alternative to finger stick blood glucose testing in adults and children with any type of diabetes (age suitability may vary by product). Monitoring with CGM typically requires the person to wear a small, disposable subcutaneous sensor that measures interstitial glucose levels for …

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