Who Should Get a CGM? Expanding the Primary Care Candidate Pool

Continuous glucose monitoring (CGM) has moved beyond its early association with type 1 diabetes and intensive insulin regimens. In this video, Jovan Milosavljevic, MD, assistant professor in the Department of Medicine at Albert Einstein College of Medicine and Montefiore Einstein, explained how easier-to-use devices, a broader evidence base, and improving coverage have widened the technology’s role in diabetes care. For primary care physicians, the question is increasingly whether continuous glucose data could answer a clinically useful question for an individual patient.

Milosavljevic placed patients treated with insulin at the top of the list because CGM can support titration and show overnight lows, postmeal excursions, and other patterns missed by intermittent testing. Randomized evidence from the MOBILE trial supported that use: among adults with type 2 diabetes treated with basal insulin in primary care, CGM use produced a greater reduction in glycated hemoglobin and more time in the 70- to 180-mg/dL range than blood glucose meter monitoring.

Potential candidates extend beyond intensive insulin users. Milosavljevic pointed to patients with problematic hypoglycemia, hospitalizations for hyperglycemia, or treatment with medications that can cause hypoglycemia, including sulfonylureas. A meta-analysis of randomized trials in noninsulin-treated type 2 diabetes found modest improvements in glycated hemoglobin and time in range with CGM compared with self-monitoring, although the intended use and likelihood of acting on the data remain important.

His photograph-versus-movie analogy captured the practical difference. A finger-stick measurement documents one point in time; CGM shows direction, timing, and context between meals, overnight, during activity, and after medication. Patients also receive immediate feedback rather than waiting for the next glycated hemoglobin measurement. For primary care, the value is not simply more data. It is the opportunity to connect a repeatable glucose pattern with treatment or behavior and make a focused, shared decision.

References:

1. Martens T, Beck RW, Bailey R, et al. Effect of continuous glucose monitoring on glycemic control in patients with type 2 diabetes treated with basal insulin: a randomized clinical trial. JAMA. 2021;325:2262-2272. doi:10.1001/jama.2021.7444

2. Ferreira ROM, Trevisan T, Pasqualotto E, et al. Continuous glucose monitoring systems in noninsulin-treated people with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Diabetes Technol Ther. 2024;26(4):252-262. doi:10.1089/dia.2023.0390

3. Centers for Medicare & Medicaid Services. Medicare Coverage of Diabetes Supplies. MLN Fact Sheet. Published February 2026. Accessed October 14, 2026. https://www.cms.gov/files/document/mln7674574-medicare-coverage-diabetes-supplies.pdf