Data-driven diabetes: Continuous glucose monitoring updates & economic impacts: Written recap

In this Managed Healthcare Executive Between the Lines video series, Estay Greene, Pharm.D., MBA, and Victoria Bouhairie, M.D., discussed the 2026 American Diabetes Association (ADA) guideline updates on continuous glucose monitoring (CGM), the clinical and economic implications of expanded CGM use, and strategies to improve patient access and coverage. The discussion also reviewed a retrospective cross-sectional study on CGM frequency and glycemic outcomes in adults with Type 2 diabetes. Greene is vice president of pharmacy management at BlueCross BlueShield of South Carolina. Bouhairie is the founder and CEO of Parry’s Wellness and Diabetes Center in Charlotte, North Carolina.

Better monitoring

Greene opened the discussion by framing diabetes as one of the primary drivers of healthcare expenditure in the United States, with direct and indirect costs accounting for roughly 25 cents of every healthcare dollar spent. Against that backdrop, the question was whether investment in real-time glucose monitoring technology could yield downstream savings through reduced complications, hospitalizations and medication burden.

The discussion began with a comparison of CGM and traditional blood glucose monitoring. Traditional monitoring, which requires the patient to perform finger-stick testing multiple times per day, provides a single point-in-time reading with no capacity for trend detection or alerting. CGM, by contrast, delivers continuous glucose readings at 5- to 15-minute intervals, with alerts for impending hyper- and hypoglycemic events. Greene described his own experience with finger-stick monitoring when he was classified as a person with insulin-dependent diabetes. “I had to test eight times a day. My fingers at the end were very, very sore after one week,” he said.

Bouhairie was direct about the clinical value of continuous data: “You can’t manage what you can’t see. And CGM truly gives you that glucose visibility in real time.” She described CGM’s capacity to identify patterns that episodic testing cannot, such as postprandial excursions (spikes in blood sugar levels that occur after meals) and nocturnal hypoglycemia. The alerts embedded in real-time CGM systems allow patients and clinicians to intervene before dangerous glucose levels are reached rather than after. “You’re able to identify patterns that finger sticks just simply cannot capture,” said Bouhairie.

Greene and Bouhairie discussed some of the challenges of CGM, including up-front cost and the need for ongoing patient training (a point the ADA standards of care address), occasional sensor adhesion issues, individual sensitivity to the device adhesive and “technology fatigue.” Bouhairie said, “Is it too much data even for primary care? Sometimes we hear that.” She also noted that traditional finger-stick monitoring still has a role in confirming when CGM readings are extremely high or low.

Behavior change

Bouhairie was enthusiastic about the effect that CGM can have on patient behaviors, particularly their eating habits. She described a patient who thought sweet potatoes, a complex carbohydrate, would have a minimal effect on her glucose levels. CGM revealed otherwise, and the patient was able to compare her individual glycemic response against that of a sibling using the same device whose blood sugar didn’t spike. “You really get that real-time feedback, and people do change their behaviors due to that,” she said.

Bouhairie spoke about a connection between behavioral change and cost. “If people are catching the highs before they get there, that means we’re going to, over time, improve hemoglobin A1c [HbA1c]. We might be able to deintensify medications. If they’re able to capture the lows, then it’s going to prevent hospitalization,” she said. For payers evaluating the total cost of care, the chain reaction of visibility into real-time blood glucose levels leading to behavioral change leading to reduced utilization of acute healthcare services and, in some patients, medication deintensification represents the economic rationale for broader CGM coverage.

2026 ADA guideline updates

The 2025 ADA guidelines recommended CGM for patients on insulin therapy, with consideration for those on noninsulin agents carrying hypoglycemic risk, most notably sulfonylureas. A 2026 update expanded these recommendations considerably, Greene explained. The guidelines say that CGM is now indicated for children and adolescents with diabetes on insulin therapy, those on noninsulin agents that might produce hypoglycemia and those “in any diabetes treatment where CGM aids in management.”

The guidelines also addressed third-party payer access, Greene continued, stating that CGM coverage should be maintained regardless of a patient’s age or current HbA1c. Greene said he agreed with that. “You don’t want to take away one of these devices that helped them achieve their goal whenever they hit their
[HbA1c] level.”

Bouhairie discussed the limitations of HbA1c for monitoring diabetes. “You can have a normal HbA1c, and that patient will have hypoglycemia and hyperglycemia or even glucose variability that’s still present. So, a patient can look controlled based on HbA1c but still have dangerous lows, which can result in increased mortality,” she said. Bouhairie noted that the ADA guidelines mention time in range, the amount of time a person spends in a target range of blood glucose levels. “That’s something I always talk to my patients about,” Bouhairie said. “We do know that time in range when it comes to diabetes control is very important because we know that there’s decreased glucose variability if you have the majority of the glucose levels within that normal range. So, it’s something that I always talk about whenever I’m discussing CGM use. And the ADA also emphasizes time in range when it comes to CGM use and for long-term outcomes.”

Presymptomatic Type 1 diabetes

Bouhairie highlighted the critical importance of presymptomatic screening for Type 1 diabetes, emphasizing that early identification allows clinicians to move from a reactive to a proactive model of care. She explained that detecting patients in Stage 1 (autoantibody-positive, asymptomatic) or Stage 2
(autoantibody-positive with dysglycemia) of Type 2 diabetes creates opportunities to educate patients about diabetes and diabetes ketoacidosis (DKA), initiate CGM monitoring and consider disease-modifying therapies that can delay progression to Stage 3. Notably, she pointed to data showing that CGM monitoring in at-risk individuals substantially reduces DKA risk, from approximately 40% to less than 5%, and stressed that rather than waiting for DKA to occur, the goal should be to identify those with presymptomatic Type 1 diabetes early and educate them and their caregivers.

CGM in noninsulin users

The extension of ADA recommendations for CGM to patients not using insulin or hypoglycemia-inducing agents was a clinically meaningful development, Greene and Bouhairie noted. For this population, CGM primarily functions as an educational and behavioral tool rather than a safety-monitoring device. Patients can observe how specific foods, activity, stress and sleep patterns affect their glucose in real time and adjust accordingly. Bouhairie described the value in terms of engagement. “Even if you’re on pills, you still can benefit from changing your lifestyle,” she said. “You still see what food does in terms of your glucose levels and are able to identify which foods are troublesome, especially to you as an individual, so it’s a more person-centric approach.”

Greene and Bouhairie discussed the difference between the prescription and over-the-counter CGM. Real-time prescription CGM is FDA approved for therapeutic decision-making, including insulin dosing, and provides both alerts and clinician portal access. Over-the-counter CGM is intended for lifestyle insight, is not FDA approved for therapeutic management and carries no alert functionality. They are not interchangeable products, and coverage decisions would reflect that clinical distinction, they noted.

A study of CGM frequency

Greene and Bouhairie discussed the results of the association between frequency of CGM and glycemic control among people with Type 2 diabetes. The study was published in JAMA Network Open in October 2025. The retrospective, cross-sectional investigation included 9,258 patients. The researchers categorized “CGM frequency” by the number of sensor days of CGM use during a 12-month postindex period (frequency 1, ≥1 to ≤90 days; frequency 2, >90 to ≤180 days; frequency 3, >180 to ≤270 days; frequency 4, >270 days). The primary finding was that higher CGM use frequency was associated with greater HbA1c reduction across all medication categories, with the most pronounced drop occurring within the first three months of device use.

Bouhairie attributed the early effect to rapid correction of high-impact behaviors: “Those who are on it, they are able to really change those big drivers of hyperglycemia. They’re looking at the meals and what’s spiking their blood sugars, and they’re making the change. They’re stopping late-night eating because they’re actually seeing what the blood sugars are doing.” At six months, outcomes leveled off in most frequency groups (the high-frequency group was the exception). “It really tells me that at that six-month point, we really have to make sure that we’re keeping an eye on our patients and making sure that they’re still engaged, giving them motivational interviewing, undergoing motivational interviewing so that they can continue to have active engagement with the device,” Bouhairie said.

Multidisciplinary education and access

Training and ongoing education were identified as prerequisites for effective CGM use and a key factor in sustaining patient engagement over time, agreed Greene and Bouhairie. Bouhairie described a multidisciplinary model in which all clinical staff are trained in CGM use and diabetes technology, enabling consistent patient support at every encounter rather than only during physician visits. Referrals to accredited diabetes self-management education and support programs, credentialed by the ADA or the Association of Diabetes Care and Education Specialists, can help patients benefit from CGM, Bouhairie said.

Takeaways

Bouhairie praised the ADA for revising its guidelines to recommend CGM for a broader group of patients. “CGM is a very useful tool, and again, the ADA did a great job in 2026 with expanding that recommendation to who can benefit from it,” she said. She said CGM means providers can have a “more patient-centric discussion when it comes to therapeutic decisions.” She also stressed what she sees as the limitations of HbA1c monitoring. “We really have to go beyond that, knowing that time in range is huge when it comes to complication.”

Bouhairie said CGM is a great tool and that “we just continue to advocate for our patients” to providers who might not be comfortable prescribing CGM, to patients who might not be comfortable using it and to payers “that are a little bit more restrictive.”

“The onus is on us, all of us,” Bouhairie continued, “to get together and really help to promote and increase the availability of CGM to all who will benefit.”