Real stories by real family physicians
Using a continuous glucose monitoring system (CGM) can help some patients who have diabetes keep their blood glucose level from getting too high or too low.
Health care innovations allow patients living with chronic diseases such as diabetes or high blood pressure to monitor their condition. This helps them reach out to their family doctor in a timely manner, when necessary. One example for some patients living with diabetes is the continuous glucose monitoring system (CGM).
A CGM is a product with a small sensor that sticks to the back of the arm with an adhesive. Using a CGM, patients who have diabetes can measure their blood glucose throughout the day. This information helps them make quick, day-to-day adjustments to keep their blood glucose level from getting too high or too low. Adjustments may include changes to their eating habits and exercise level.
Using a CGM isn’t right for every person who has diabetes. It’s also important to know that your health insurance might not cover this type of monitor. Some plans will only cover a CGM for patients who meet specific requirements set by the insurance company. Your family doctor can help determine the right approach to monitoring your blood sugar level.
Mary (not her real name) is a patient who sees a family doctor at my clinic. As an airline employee, she found it challenging to live with diabetes. Her busy travel schedule made it hard to manage her diabetes as well as she wanted to. She had been taking metformin for a while, but her A1C level was still high at 8.9%. This is equivalent to a blood sugar level of 240 milligrams per deciliter (mg/dL). A normal A1C level is below 5.7%. A normal fasting or pre-meal blood sugar level is less than 99 mg/dL. Mary felt especially frustrated about trying to fit routine diabetes check-ups with her family doctor into her schedule.
Mary’s family doctor recommended that she try a CGM. You have the freedom to choose how frequently you use a CGM. One option is to apply a new CGM sensor every 14 days without any gaps in use. Another option is to only use a CGM sensor for 2 weeks (14 days in a row) out of every month. This gives the skin on your arm a break from any irritation. During the weeks when you aren’t using the CGM, your doctor may recommend checking your blood sugar with a blood glucose monitor (fingerstick test). You can get results from a CGM using a smartphone, a computer, or a special reader. If your doctor’s office uses a patient portal, you may be able to submit monthly CGM reports into your medical record electronically.
After talking with her doctor, Mary decided to use a CGM to measure her blood glucose for 2 weeks per month. Information from the CGM helped her make real-time adjustments to her activities and dietary choices. She submitted her monthly CGM report to her family doctor through our clinic’s patient portal. Her doctor reviewed the report each month. Then, she gave Mary the option of scheduling an in-person office visit, a telemedicine appointment, or a virtual visit through the patient portal (also called an e-visit). Using a combination of telemedicine and virtual visits, Mary was able to check in with her doctor every month at times that fit into her schedule.
These monthly reviews of Mary’s blood glucose levels increased communication between her and her family doctor. They were able to work toward her diabetes health goals more effectively. For example, they discussed dietary changes and regular exercise that would work with her travel schedule. Mary’s doctor also prescribed a new once-a-week injectable medicine. It’s designed to increase insulin production and lower blood sugar. It can also slow down digestion, decrease Mary’s appetite, and help her lose weight. This medicine fits Mary’s lifestyle and supports her health goals.
After 4 months of using a CGM for 14 days per month and getting regular feedback, Mary and her doctor are excited to see an improvement in her diabetes health. She started the new injectable medicine and has lost 10 pounds. Her A1C is now 6.9%, which is equivalent to a blood sugar level of 168 mg/dL. Using a CGM, consistently taking her medicine, and increasing communication with her doctor gave Mary the confidence and support to take charge of her diabetes. Telemedicine and virtual visits have worked well for her routine diabetes check-ups. Mary’s doctor has also reminded her to schedule an in-person office visit soon for an annual eye exam, a foot exam, and lab testing.
If you use a CGM, keep a file folder on your computer or smartphone to store your monthly reports. This will help you be organized when it’s time to share your most recent report with your family doctor. If you have a compatible smartphone, you may be able to share CGM data with your health care team remotely. Check with your doctor to find out.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.