Understanding Traditional and Continuous Glucose Monitoring

Glucose monitoring has made enormous strides in recent years, making it easier for patients with diabetes to manage

their condition. In 2024, the FDA approved the first over-the-counter continuous glucose monitor, allowing consumers to purchase the devices directly rather than going through their healthcare provider or insurance.

But is CGM the best choice for every patient?

Traditional and Continuous Glucose Monitoring

Traditional fingerstick testing (also referred to as self-monitoring of blood glucose) and continuous glucose monitoring are the two primary methods for monitoring blood sugar. Understanding how they work and what the benefits are can help drive better care decisions.

Self-Monitoring of Blood Glucose (SMBG):

SMBG involves pricking the finger to obtain a drop of blood, which is then applied to a test strip and analyzed by a glucometer. This method provides a reading at the time of testing and may require multiple tests per day, especially for those following sliding scale insulin therapy.

SMBG devices may be preferred for patients who don't need insulin therapy, and in certain other scenarios. Here are some of the benefits:

1. SMBG devices and supplies are generally more affordable and widely available.
2. They don't require special training.
3. They provide immediate readings and can confirm hypoglycemia or hyperglycemia.
4. They are convenient and less disruptive than the frequent alerts sent by CGM monitors.
5. SMBG is typically fully covered by CMS, especially for patients with T2D who aren't on insulin. In contrast, CGMs are only covered by Medicare if the patient meets the specific eligibility requirements, including insulin use or documented cases of hypoglycemia, a prescription, training, and follow-up care. Even then, only 80% of the cost is covered under Medicare Part B, leaving patients to pay the remaining 20% after the deductible is met.

Continuous Glucose Monitoring (CGM):

CGM involves inserting a small sensor under the skin, often on the abdomen or arm. The sensor automatically estimates blood glucose levels in the interstitial fluid every few minutes. This data is transmitted to a receiver or smartphone, providing trends and alerts for glucose levels.

Many patients appreciate the ability of CGM to reduce the need for frequent fingerstick tests, although it is still recommended to test as needed with a glucometer to confirm abnormal glucose levels and to ensure the CGM readings are accurate.

According to the American Diabetes Association, continuous glucose monitoring helps patients by:

1. Providing more detailed, precise data
2. Providing feedback in real time
3. Monitoring trends that can inform treatment decisions
4. Reducing the frequency of emergency events and complications

Which Method Is Right for Different Types of Diabetes?

Type 1 Diabetes (T1D):

CGM is beneficial for individuals with Type 1 diabetes, because it offers continuous feedback to help manage insulin levels and reduce the chances of hypoglycemia. A 2023 study found that CGM users experienced better glycemic control compared to those using SMBG.

Type 2 Diabetes (T2D):

CGM can also aid in managing glucose levels and reduce the risk of complications for insulin dependent Type 2 diabetes patients. However, for patients who aren't insulin dependent, SMBG is effective when used consistently alongside lifestyle changes. The American Diabetes Association notes that structured SMBG can help individuals with T2D whose blood glucose levels are above their goals.

How Remote Patient Monitoring Supports Patients with Diabetes

Continuous glucose monitoring isn't necessary for every diabetes patient, and its expense and availability can be prohibitive for some. Remote patient monitoring (RPM) programs can help patients who use traditional SMBG devices by enabling them to digitally transmit their readings to their care team. This allows providers to review the data regularly, identify trends, and proactively engage with patients.

RPM programs provide an effective alternative to CGM by combining traditional glucometers with digital tools and support from a care team while also lowering costs, expanding access, and resulting in better outcomes.

At HealthXL, we remain committed to providing exceptional patient care while supporting practices with reliable, consistent services. Contact us to learn more!