CGM for Type 2 Diabetes: As important and impactful as it is for T1D
The content in this article should not be taken as medical advice. Please consult your healthcare provider regarding your individual health needs and Dexcom alert settings.
When patients visit Dr. Thomas Grace of the Blanchard Valley Diabetes Center in Findlay, Ohio, and are diagnosed with diabetes, they might be surprised his first prescription isn’t medication.
“The primary prescription I write for people with diabetes for whom continuous glucose monitoring is indicated is a continuous glucose monitor (CGM), because it’s vital to understand how our behavior affects our glucose before adding medications,” Grace said. “A Dexcom CGM is a tool that can give insight into the quality of foods we eat and help reinforce proper dietary decisions and the importance of getting regular physical activity. All the major academic bodies recommend behavior modification as the very first thing to treat people with Type 2 diabetes, and CGM is the tool that helps patients understand why that is so important.”
Grace can certainly vouch. As Dexcom’s head of advocacy, a doctor specializing in diabetes treatment and someone who also manages his Type 1 diabetes with a Dexcom CGM paired with an insulin pump, he knows the positive impact a CGM can have on quality of life, mental well- being and overall physical health.
And as a seasoned clinician, he also believes in the power of CGM for Type 2 diabetes and advocates for patients to use the technology when indicated. It helps his patients improve their daily diabetes management. And after he prescribes medications, the CGM glucose readings help him adjust them appropriately for patients based on what they need.
“A Dexcom CGM is a tool that can give insight into the quality of foods we eat and help reinforce proper dietary decisions and the importance of getting regular physical activity.”
- Dr. Thomas Grace
“It's just the most important prescription I can write for anyone with Type 2 diabetes,” he said. “Because this is a technology that people with diabetes, whether Type 1 or Type 2, deserve to have. Our patients do better when they have access to their glucose data consistently throughout the day. And as a clinician, I'm so much more informed about my patients and I can make more educated choices for them with the CGM data.”
Grace describes a CGM to patients as a wearable small electronic device on top of the skin with a small wire that penetrates underneath to monitor in real time the glucose in the body’s interstitial fluid. As it measures, it also transmits glucose readings to an external device, either a smartphone*, smartwatch* or receiver.
“The accuracy is as good as using a traditional glucometer1, the difference being a CGM gets readings consistently and can predict where your glucose is not only currently at but also where it's going,” Grace said. “This is very powerful information for someone with diabetes using this technology, because they and we clinicians can adapt based on the trends we get from a CGM.”
And using a CGM eliminates the need for fingersticks†, a common pain point for those with diabetes.
†Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
†Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
“Continuous glucose monitoring has gotten so accurate1 over the last few years that it is now deemed by the FDA to be non-adjunctive use, meaning we no longer need to poke our fingers because the technology is as accurate, if not more accurate,1 than any of the glucometers on the market,” Grace said.
Three benefits of CGM for Type 2 diabetes
Grace feels strongly about Type 2 diabetes monitoring and offers three reasons why people with Type 2 need a CGM:
1. Knowledge is power – People with Type 2 diabetes deserve to have the same insights about their glycemic management as people with Type 1. They also benefit significantly from learning about their dietary choices.
“We live in a world where consuming too many carbs is too easy to do, and a lot of the times this goes overlooked,” Grace said. “We tell patients don't eat carbs, but most people without a CGM don't truly understand what that means and they don't dig into it deep enough. Having a CGM instantly gives insight to the foods you eat that benefit your glycemic control and the ones that are harmful.”
2. Behavioral modification – A CGM reinforces good behaviors, such as participating in more physical activity, that improve the lives of those managing Type 2. Seeing is believing, and a Dexcom CGM helps those with diabetes see in real-time the impact of better lifestyle choices. After using a CGM, patients often come back to see Grace with stories about noticing glucose level improvement after taking a walk or adhering to a more diabetes-friendly diet.
“As we know, recommendations behind lifestyle changes are not only important but frequently overlooked in the clinic,” Grace said. “If I tell people to get more exercise, it often goes in one ear and out the other. But when I give them a tool like a Dexcom CGM that shows them why exercise is important, they're much more able and likely to benefit from that advice. When you see it, you're much more apt to explore those behaviors to get the benefits again and again.”
Grace also emphasized “exercise” doesn’t necessarily mean going to the gym for a vigorous workout.
“Any additional steps you take throughout the day help your glycemic control,” he added. “An object at rest stays at rest, an object in motion stays in motion.”
3. Boost in confidence, well-being – When people with Type 2 can tie their behaviors to their glycemic control in addition to the medications they use, they can see what happens when they diligently take their medications, make the right dietary choices and get more physical activity, and their confidence in managing diabetes goes up. And when they're confident in treating diabetes, their outcomes are much better, Grace said.
“When you trust that your medications are working, when you trust that you're making the right dietary choices, when you trust that going for a walk is beneficial for you because you can see your glucose is running better, then you're much more able to stay on track with taking your medications appropriately, with eating the right things and with getting regular physical activity,” Grace said. “When you know you have a device that helps you manage your diabetes 24/7, 365, you simply have a better peace of mind. If you have a tool that shows your glucose in real time consistently throughout the day, you do better.”
Coverage considerations for CGM
While the best way for someone to get a CGM is to ask their doctor for one, be aware Medicaid and insurance sometimes don’t cover the technology.
“It is currently covered and standard of care for anyone on insulin or at risk for hypoglycemia, and several insurances have been more progressive over the last few years and are also covering it for people not on insulin,” Grace said. “Medicaid is state by state. Some states, such as Ohio, are progressive and you do not need to be on insulin to be able to get a continuous glucose monitor. Other states lag. I hope in the near future at least all Medicaids will cover this for people with diabetes on insulin therapy at bare minimum.”
It also pays to read the fine print of an insurance policy.
“A lot of people don't know their baseline insurance coverage, and once you get a prescription there may be different ways to fulfill your prescription,” Grace said. “Some patients have CGM covered as a pharmacy benefit, others have this covered as a durable medical equipment benefit. If you don't know your specific coverage, you can call your insurance company and ask them. If you don't have good coverage, you can write your insurance company a letter letting them know CGM is something you deserve.”
In the end, you are always your own best advocate, he added.
“So, speak up,” Grace said.
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*Smart device sold separately. To view a list of compatible devices, visit dexcom.com/compatibility. †Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings.
1 Garg SK, et al. Accuracy and Safety of Dexcom G7 Continuous Glucose Monitoring in Adults with Diabetes. Diabetes Technol Ther. 2022;24(6):373-380.
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