Add continuous glucose monitoring to your practice: a step-by-step guide

Continuous glucose monitoring (CGM) provides more data about daily glucose trends than finger-stick measurements. Here’s how to start a CGM program in your practice.

• Choose a device. Right now there are three devices on the market for professional CGM. All have different technical pros and cons (for example, one has an “unblinded” mode that allows patients with a compatible smart device to view their glucose data in real time), and all have different pricing options (some offer one price for a bundled “starter kit” of sensors and receivers, while another sells them a la carte). View this CGM product comparison and request demos to help you choose one.

• Get administrative buy-in. Administrators will need to understand the challenges of treating diabetes and the benefits of CGM for your program to be successful and lasting. They’re more likely to buy in if you can tell them what it will initially cost (less than $1,000 for most practices) while also mapping out the billing and reimbursement process, staffing needs, and projected amount of use.

• Designate a staff champion. To take some of the work off your plate, designate one or two staff members to become experts on the CGM process. They can help identify good patients for CGM, be in charge of storage and maintenance of devices, as well as place sensors on patients and educate them on things like keeping a food and activity journal. Depending on the tasks you delegate to them, the staff champions could be medical assistants, licensed nurses, dietitians, or diabetes educators.

• Select patients. Good candidates for CGM include those with uncontrolled diabetes, lack of hypoglycemia awareness, discordant A1C and finger-stick readings, dawn phenomenon, postprandial hyperglycemia, nocturnal hypoglycemia, suspected medication nonadherence, and special populations (e.g., chronic kidney disease or pregnancy). Once your staff champion has compiled a list of good candidates and confirmed they want to try CGM, distribute the list to all of your clinic’s physicians.

• Establish a standardized workflow. Getting the patient selection process right should help with the first part of the workflow: securing prior authorization. Once you’ve got that for a given patient, you can place the sensor on the patient, either during a scheduled office visit or at a separate appointment. Establish a standard process for educating patients on how long to wear the sensor (this varies some by device), what to do while they’re wearing it (track meals, activities, sleep, etc.) and how to return it (by mail or in person) for data download. Designate who will download the data, compile the statistical report, and schedule a follow-up with the patient to discuss it. Lastly, make sure you have a standard process for billing and coding to ensure you get properly reimbursed for CGM.

For additional guidance, see "Tips to streamline workflow and increase likelihood of coverage for CGM" (FPM Quick Tips blog).

Read the full FPM article: “Implementing Continuous Glucose Monitoring in Clinical Practice.”