Continuous Glucose Monitoring (CGM)

Continuous glucose monitoring (CGM) means an improvement in blood glucose regulation for many people with type 1 diabetes. Not everyone receives reimbursement for a continuous glucose sensor from their health insurance. There are rules that apply to this.

GoOD TO KNOW:

With continuous glucose monitoring, a small, flexible needle measures the glucose level.

To receive reimbursement for a glucose sensor, a person must meet strict conditions.

If you are being treated at Diabeter, you can check whether you are eligible to use a CGM.

CGM in Type 1 Diabetes

Continuous glucose monitoring works with a small, flexible needle placed under the skin. This needle is connected to a sensor. The sensor measures the glucose level every 5 minutes, 24 hours a day. This allows a person to continuously know their glucose level.

TYPES OF CGM IN DIABETES

There are different glucose sensors from various manufacturers:

Dexcom

With this sensor, it is not necessary to perform finger pricks to ensure accurate readings.

The Dexcom glucose sensor is replaced every ten days. The sensor can be connected via software to various insulin pumps and/or a smartphone, enabling the possibility of an AID system (automated insulin delivery).

Guardian

With this sensor, finger pricks are usually not necessary. The glucose sensor can be used continuously for 7 days.
The Guardian glucose sensor is part of the Medtronic insulin pump. When someone connects the pump and the sensor, a hybrid closed loop is created.

This is a system in which the pump adjusts insulin delivery based on glucose levels.
The Guardian sensor can also be used independently of the Medtronic insulin pump.

Simplera

Simplera is the successor to the Guardian and offers the same capabilities as the Guardian.

FreeStyle Libre 3 (FSL3)

Finger pricks are also not necessary with this sensor for accurate readings.
The FSL3 can be used in combination with the mylife YpsoPump.

The sensor is the successor to the FreeStyle Libre 2 (FSL2). However, the FSL2 is a flash glucose sensor that qualifies for broader reimbursement.

The FSL3 is a continuous glucose sensor.

FreeStyle Libre 2 plus

This sensor is used as a CGM (Continuous Glucose Monitor), currently with the Omnipod5, and will be deployed more broadly in the future.

THE DIFFERENCE BETWEEN CGM AND FGM

Continuous Glucose Monitoring (CGM) is different from Flash Glucose Monitoring (FGM) in the context of type 1 diabetes.
A flash glucose sensor, like CGM, continuously measures glucose levels — but the data is not always visible.

With FGM, the sensor must be scanned using a mobile phone or a dedicated scanner. FGM does offer the option for alarms when glucose levels are too high or too low.

Currently, FGM is reimbursed for everyone with type 1 diabetes through health insurance. This is not the case for CGM, which is subject to additional regulations. As a result, not everyone with type 1 diabetes can use a continuous glucose sensor.

Rules for CGM in diabetes

Continuous glucose monitoring (CGM) costs money. The health insurer reimburses these costs if you meet certain conditions.

Additionally, you must set treatment goals with your diabetes care team. For example: better HbA1c levels, more stable glucose values, or fewer hypoglycemic episodes.

CONDITIONS FOR CGM REIMBURSEMENT

The health insurer reimburses continuous glucose monitoring (CGM) if:

You are under 18 years old.
You are over 18 years old and have a high HbA1c. Specifically, your HbA1c must be above 8.0 mmol/l in at least 3 quarters within one year.
You are pregnant or planning to become pregnant.
You experience severe hypoglycemia or have hypo unawareness (difficulty recognizing low blood sugar levels).

AGREEMENTS ABOUT CGM WITH YOUR DIABETES CARE TEAM

To use CGM, your doctor or diabetes nurse fills out a form. This is a medical prescription. The form confirms that clear agreements have been made regarding CGM use:

You meet one or more conditions for CGM reimbursement.
You follow the necessary instructions to use CGM, ensuring you have sufficient knowledge about it.
You do not use FGM, and there are clear reasons for choosing CGM.
The treatment goals are documented in your medical file.
Each year, your CGM usage is reviewed to assess whether the treatment still suits you.

These agreements come from a document by the Dutch Diabetes Federation (NDF). This document can be viewed hier

OTHER CONDITIONS FOR CGM

By indicating that you want to use CGM, you also agree to the following terms:

Your diabetes care team may share the information needed for the CGM application with the glucose sensor supplier and the health insurer. This includes medical data, which will only be used to assess the application.
Your diabetes care team may share additional information if requested by the health insurer. This also only concerns data necessary to evaluate the application.
You understand that you will only receive the materials needed to use CGM once you meet the conditions for CGM.

CGM at Diabeter

At Diabeter, we aim to provide personalized treatment for everyone with type 1 diabetes. Increasingly, we recommend diabetes technology such as continuous glucose monitoring (CGM). The more technology someone uses, the more likely they are to achieve their diabetes goals.

Are you receiving treatment at Diabeter and do you meet the conditions for CGM?
Your care team will be happy to discuss how to make the best choice with you.