Are CGMs Experimental?
My husband has type 1 diabetes. A physician assistant told him the continuous glucose monitor was in the experimental stage (at least in a health insurer’s opinion). Is that true? Name Withheld
Nicholas Argento, MD, responds:
No, it's not true! Continuous glucose monitoring (CGM) is now a covered benefit for 70 to 80 percent of Americans who have commercial insurance, at least under some circumstances. Unfortunately, though, Medicare and Medicaid do not currently cover home use of CGM.
WHAT TO KNOW: A continuous glucose monitor uses a disposable sensor that is placed under the skin every three to seven days and sends a signal to a remote receiver. The receiver provides an estimated blood glucose (sugar) level every five minutes. This allows you to track whether blood glucose is moving up or down (and how fast). The receiver can sound an alarm if the level is too high or too low, or if it is rising or falling too rapidly, so you can take action to correct it. It allows you to detect patterns of highs and lows, so that treatments and habits can be modified to safely improve control.
CGM devices do not replace the need for checking blood glucose with a meter, which is used to calibrate the CGM device and to confirm the glucose level if it is going to be used for treatment.
A landmark study proved that full-time use of a CGM device allows adult patients with type 1 diabetes who have high average blood glucose to lower their blood sugar, with no increase in the risk of hypoglycemia (low blood glucose). A related study proved that a patient with good average blood glucose was more likely to stay in control by using CGM, with less risk of hypoglycemia.
FIND OUT MORE: Two companies have CGM devices available in the United States: DexCom (dexcom.com) and Medtronic Diabetes (medtronicdiabetes.net).
TAKEAWAYS: CGM is a clinically proven, powerful tool to help people with diabetes who use insulin get their blood glucose under better control and reduce hypoglycemia. Most insurance companies will now cover home use of CGM in type 1 patients and in some people with type 2 who require insulin, especially those who have problems with hypoglycemia. If insurance refuses to cover CGM, file an appeal. Get your doctor's help—ask your provider to send a letter of medical necessity to your insurer. Don't take no for an answer!