What to Know Before Incorporating CGM Data into Your Practice

Continuous glucose monitors (CGMs) have been used for diabetes management for over 20 years, but they're only recently being explored for patients without diabetes. Research has shown that CGMs could lead to better diabetes prevention for high-risk populations such as those with polycystic ovarian syndrome (PCOS), cystic fibrosis, and obesity. However, CGMs are now being used to help optimize the glucose levels of everyday patients in hopes of improving their physical and mental health.

According to Ashley Koff, RD, personalized nutrition expert, CGMs should be used for every patient, regardless of whether they have diabetes. “I actually think it’s crucial for most patients,” said Koff, who is founder of The Better Nutrition Program, which helps practitioners incorporate CGM data into their patient care. “To be able to show patients concrete data on what is working and not working for their bodies is extremely helpful as a clinician.”

Unlike traditional glucose testing, like the hemoglobin A1C, which shows a three-month average, CGMs provide in-depth data that can detect minor blood sugar fluctuations, measuring a patient’s blood sugar every five minutes. CGMs help tailor patient management plans by providing real-time data on how various factors affect glucose levels. This can be particularly useful for understanding the impacts of diet, stress, and hormonal changes, Koff explained.

"We have 40 plus factors that impact your blood sugar; about ten of them are nutrition, and about three of them are carbohydrate related,” said Koff. “One of the mistakes that so often happens is making it all about nutrition and carbohydrate intake. Oftentimes, patients are told to make only diet-related changes, and when they come back, their hemoglobin A1C isn’t any better.”

Koff also explained that CGM data serves as a valuable educational tool, motivating patients by showing real-time effects of their lifestyle choices and allowing for the experimentation of various health interventions.

While CGMs can be extremely helpful when personalizing nutrition and lifestyle interventions, Koff stressed the importance of educating yourself and getting your operations systems in place before implementing them into your patient care, recommending that practitioners:

Invest in a Comprehensive System: Practitioners should invest in a system that manages all aspects of CGM usage. This includes collecting and analyzing data, educating the patient on using the device, and integrating the insights into patient care. The system should be straightforward for both the practitioner and the patient to avoid complications and ensure it produces valuable insights.

Track Other Health Factors for Accurate Interpretation: Practitioners should consider monitoring several factors besides CGM data to provide comprehensive care and accurately interpret glucose readings. These include nutritional intake, physical activity, stress levels, sleep patterns, menstrual cycle and hormonal changes, alcohol consumption, and supplement/medication use.

Educate Patients Thoroughly: It is crucial to explain to patients why they are using the CGM and what to expect from it. Proper education helps in setting realistic expectations and improves compliance and satisfaction.

Address Other Health Concerns First: Consider the individual health conditions that may be impacting glucose levels as well as the needs of each patient before implementing CGM. “For instance, if somebody's digestion is very clearly not working well, I would work on diet; I would get digestion at least in a little bit of a better spot before I started to look at metabolic health,” said Koff.

Set a Personalized Target Range: Glucose ranges should differ from patient to patient, and it's important to set realistic expectations. For instance, some patients trend lower, while other patients may experience higher baselines.  

Cost-Benefit Analysis: Out-of-pocket costs for CGMs can average around $200 per month, including the actual sensor, the app, and paying for a practitioner to interpret the results. Even with a prescription, most insurance companies will not cover CGMs if a patient doesn't have diabetes or other blood sugar-related conditions. It’s important to consider that, depending on their circumstances, this may not be an accessible tool for some patients.

Prepare for AI Integration and Challenges: Stay informed about the developments in AI for analyzing CGM data, but recognize that AI is not yet a substitute for a practitioner's expertise. Koff explained that practitioners should prepare for how AI can support, not replace, their role in interpreting CGM data.