ASHP Midyear: Pharmacists Play Key Role in Optimizing Continuous Glucose Monitoring for Diabetes Management

Continuous glucose monitoring (CGM) has emerged as a powerful tool to help personalize and optimize diabetes management, but fully realizing its benefits requires active engagement from healthcare providers like pharmacists. Kevin Cowart, PharmD, MPH, BCACP, CDCES, assistant professor from the University of South Florida Taneja College of Pharmacy discusses how CGM can uncover important patterns in patients' glucose levels, enabling more timely adjustments to medication therapy rather than waiting for periodic A1C tests. Pharmacists, in particular, can play a crucial role in helping patients get the most out of CGM by teaching them proper sensor application and maintenance, reviewing their CGM data and ambulatory glucose profiles, and using those insights to overcome clinical inertia in managing medications.

Pharmacy Times: What are the benefits of using a continuous glucose monitor (CGM) for people with type 2 diabetes?

Kevin Cowart: Continuous glucose monitoring really helps people to uncover some of the "aha moments" behind their glucose and their whole glycemic profile. It helps patients to help with activation, help with engagement, and then in clinical trials have been shown to improve a1c as well as reduce hypoglycemia.

Pharmacy Times: How can CGM data be used to optimize medication therapy, including insulin dosing and oral antidiabetic medications?

Cowart: CGM really helps to personalize the approach that we take to initiating medications adjusting medications because we have this more data that we didn't previously have. It helps us to uncover patterns that really help to drive some of these more timely changes in medication therapy, instead of waiting for an A1c which sometimes takes 3 to 6 months before we will have to make a change. We can now make that change a lot sooner and help overcome clinical inertia.

Pharmacy Times: Recently, the FDA cleared an OTC CGM. How does this help improve accessibility for patients with type 2 diabetes?

Cowart: Well, the OTC CGM devices are targeted as biowearables and more in the wellness space, but they still are used in people that do not live with diabetes, and even those that do live with type 2 diabetes on just orals. We still do prefer to use the prescription continuous glucose monitoring devices in people that are on insulin.

Pharmacy Times: Are there any limitations to CGM?

Cowart: Very few, if any. It's a very low-risk intervention. There is certainly redness and itching and minor bleeding that can occur at the site. Patients do often complain of accuracy concerns. We obviously don't want patients to compare their blood glucose monitoring results with their CGM unless they don't feel the same way as their numbers look, but there's very few limitations to the use of CGM in practice.

Pharmacy Times: How can pharmacists use CGM data to improve medication adherence in patients with type 2 diabetes?

Cowart: So pharmacists can really help to, again, overcome clinical inertia that we see in the management of a lot of chronic diseases, but in the space of diabetes management, can really help with helping to adjust medication sooner, and helping to titrate insulin, and then maybe even decreasing insulin if the patient is experiencing hypoglycemia because we have so much more data around the CGM than we previously had before, which is traditional blood glucose monitoring.

Pharmacy Times: How can pharmacists best educate patients on CGMs, including how to use it effectively and discuss OTC CGMs?

Cowart: I think pharmacists have a large role in helping patients to learn some of the tips and tricks with regards to CGM, be it, how to apply the sensor, how to make sure the sensors don't fall off, how to get the most from using the sensor, making sure that they're having a routine follow up, because a lot of patients will actually wear a sensor and not ever know that there's an ambulatory glucose profile that's generated with a very detailed clinician view of the glucose and as pharmacists, we can meet with our patients to be able to help go over that ambulatory glucose profile.

Pharmacy Times: Is there anything else you would like to add?

Cowart: One of the biggest challenges that our health system has experienced with implementing CGM as a clinical service line has been integration into the health record. That's something that we're having to double document at times to be able to track metrics and track patients and track outcomes. So I think with more time, we'll be able to see that there's more interoperability that we'll see with CGM and our electronic health record.