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6 Tips for CGM Success
December 16, 2024Finger sticks have long been a source of frustration for nursing home and assisted living residents and staff alike. That’s because, when staff are overwhelmed and juggling tasks, frequent finger sticks to check glucose levels in those with
diabetes takes up precious time – time they would rather spend on direct care. And for residents, this intervention is uncomfortable, even painful, as well as an interruption. The advent of continuous glucose monitors (CGMs), wearable medical systems that continuously monitor blood glucose levels and transmit data in real time, can reduce the challenges
associated with finger sticks and improve overall diabetes management.
While these devices have been around for several years, noted Steve Austin, RPh, PharmD, BC-ADM, a consultant pharmacist at PharMerica, “technological advances from the earlier models have been substantial.” While there are still challenges when using these devices in older adults, there are distinct advantages. With a high rate of diabetes in this population, it is essential to identify and use tools and technology to maximize both care and quality of life for these individuals.
Steps to CGM Utilization
Whether you’re already using CGMs with your residents or considering it, here are 6 key tips:
1. Make sure staff members understand the technology. This includes information such as how long it takes for
the device to warm up, how many and what pieces are involved (e.g., typically the reader, the transmitter, and the sensor), and how often the data is transmitted. Provide adequate training so they know about all the information they can get from these devices and how to use this data. Some CGMs offer a provider dashboard that you can use to create a report over a certain period of time to track patterns and progress.
2. Realize these devices aren’t a panacea. CGMs are generally very effective. They measure glucose every 1-5 minutes and record this data every 5-15 minutes; and they offer alerts for specific high and low thresholds. Nonetheless, there will be times when blood glucose monitoring via traditional finger sticks are appropriate and even necessary. For instance, said Austin, “If someone is starting to feel ‘a little funny,’ but the CGM says that their blood glucose is normal, you might want to do a finger stick just to double check that everything’s okay.”
3. Realize that CGMs may be covered by insurance. Just last year, the Centers for Medicare & Medicaid Services (CMS) expanded coverage for CGMs. Specifically, Medicare Part B and the Durable Medical Equipment (DME) benefit cover CGMs with a prescription if: the person has had two or more level 2 hypoglycemic events that recur even after multiple treatment plan modifications and/or one level 3 hypoglycemic event accompanied by altered mental or physician status that requires third-party assistance to manage. Medicare Advantage and state Medicaid plans also cover these devices. Moving forward, coverage is likely to expand further, as “evidence is starting to support the use of these devices even for individuals who are in the early stages of the disease or are pre-diabetic,” Austin said, adding that the use of CGMs helps people and their practitioners control blood sugars “significantly.”
4. These devices generally are safe and effective for older individuals, even those with fragile or thin skin. To prevent problems such as skin tears or bruising, products like adhesive remover wipes and protective barrier wipes can help. While these devices may be a bit uncomfortable at first, most people get used to them fairly quickly. However, for individuals with dementia, for example, who may try to remove the device, it may be appropriate and safer for the individual to place it on a part of the body where they can’t reach it.
5. Be prepared to train residents and families about how these devices are used. “There’s a bit of a learning curve, but once people get used to a CGM, they usually prefer it over having blood glucose sticks four times a day,” said Austin. He added the good news is that it doesn’t take long to learn. “You don’t have to be especially tech savvy,” he observed. However, people will need to either have a monitor or a special app on their phone, and they will need to keep their phone close by and charged so they can receive information and alerts. He noted that there are lots of online videos and tutorials that can help so you don’t have to reinvent the wheel. It also will be helpful to remind residents and their families that CGMs have been shown to improve glucose management and reduce the number of highs and lows that can contribute to falls and other issues.
6. Engage the pharmacist in diabetes management. As CGMs are more widely used and research documents their benefits, more pharmacists are up to date on these devices, know how the technology works, and understand requirements for insurance coverage. More of these practitioners, noted Austin, also are becoming diabetes certified and have special training in how to manage diabetes and get the best possible outcomes.
In 2021, the American Association of Clinical Endocrinology clinical practice guideline for the use of technology in diabetes indicated that CGM devices reduce hemoglobin A1c in older adults, improve quality of life, and reduce the incidence of hypoglycemia. With a rapidly growing aging population and older adults wanting to stay active and independent, it behooves practitioners, facility staff, residents, and families alike to know about CGMs.