A Pharmacist's Guide to Continuous Glucose Monitoring

• Published in: Pharmacy Times Health Systems Vol. 13; no. 2
• Main Author: Khaimova, Rebecca M
• Format: Magazine Article
• Language: English
• Published: Cranbury MultiMedia Healthcare Inc 12.03.2024
• Subjects: Clinical medicine; Drug therapy; Gestational diabetes; Glucose monitoring; Hypoglycemia; Insulin; Patients

Depending on the state, pharmacists can practice under medication therapy management (MTM), comprehensive medication management (CMM), and/or collaborative drug therapy management (CDTM).5 Determined by state regulations, pharmacists are able to prescribe CGM devices based upon guideline recommendations and provide adequate training to patients and caregivers. Literature Review of CGM in T2D While the benefit of CGM in improving glycemic control and reducing hypoglycemia in patients with T1D has been established, recent literature also supports the use of CGM in patients with T2D.8-12 Similar to patients with T1D, patients with T2D using intensive insulin regimens require BG monitoring (BGM) multiple times per day. Use of both isCGM and rtCGM in those with T2D using intensive insulin regimens has been associated with significant reductions in HbA1C at 6 months compared with BGM.13-15 A study (NCT02082184) by Haak et al utilizing isCGM found a glycemic benefit only in a subset of patients younger than 65 years.13 However, Ruedy et al found that rtCGM use was associated with improvements in HbA1C in a population 60 years or older, suggesting that benefits may span all adult patients.14 In addition to being associated with improved glycemic control, Haak et al found that isCGM use was associated with a reduction in time spent in the hypoglycemic range.13 On the other hand, Ruedy et al and Beck et al did not find an association between rtCGM and a reduction in hypoglycemia in patients using intensive insulin regimens, though rates of hypoglycemia were low at baseline in both studies.14,15 Participants in Beck et al expressed high satisfaction with CGM use and low perceived hassle associated with the device, though there was no difference in change in quality-of-life scores between the groups.15 Given the benefits of CGM use in patients using MDI, there has been increasing interest in the use of CGM in patients with T2D using basal insulin and noninsulin regimens. Several randomized and observational studies have found that CGM is associated with HbA1C reductions in those using basal insulin without bolus insulin or noninsulin therapies, with the greatest impact seen in those with the highest baseline HbA1C.16-21 Martens et al found that rtCGM use for an 8-month period was associated with a greater time in range (TIR) compared with BGM (TIR, 59% vs 43%; P .001).16 The majority of studies in those using basal insulin without bolus insulin or noninsulin regimens did not assess the impact of CGM use on hypoglycemia.17-20 One study (NCT04854135) that assessed the incidence of hypoglycemia or severe hypoglycemia in patients using oral hypoglycemic agents with or without basal insulin did not find any differences in incidence between rtCGM and BGM use.21 An exploratory analysis in another study showed a possible reduction in time below range (TBR) in the rtCGM group compared with the BGM group.16 In addition to glycemic benefits associated with CGM use, it is possible that use of CGM may have an impact on lifestyle modifications in patients on basal insulin or noninsulin agent.