Frequently Asked Questions
Discover insights from our experts on the most pressing questions from learners!
What is the most effective treatment for a patient with diabetes who has a hemoglobin A1c (HbA1c) level >10%, refuses insulin therapy, and has limited financial resources, making newer, costly medications inaccessible?
The most effective generic treatments for patients remain metformin, sulfonylureas (or glinides), and pioglitazone. Clinicians should review the safety information for each medication to determine if it is appropriate based on their patient’s comorbidities (ie, presence of chronic kidney disease, heart failure, cirrhosis).
In some cases, when combined with diabetes self-management education regarding a low carbohydrate diet and physical activity, this patient could achieve their HbA1c goal without exorbitant costs.
I generally would use metformin extended-release (ER) to optimize tolerability, use the highest tolerable dose of sulfonylurea or glinide (assuming renal function is chronic kidney disease [CKD] stage 3 or greater), and use up to 30 mg of pioglitazone daily (assuming there is no systolic heart failure present).
If needed, acarbose can also be added at 25–50 mg three times daily with meals, unless intolerable due to gastrointestinal (GI) side effects.
With respect to glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 (SGLT2) inhibitors, the recent approval of generic liraglutide and relatively low cost of bexagliflozin, which can be purchased online (www.costplusdrugs.com for less than $50 per month), make these agents potentially useful in patients with diabetes who have limited financial resources.
If you would like to learn more, please check out our clinical case study by Dr. Peters, “CGM Use in Newly Diagnosed Patients: A Patient Case Study,” here.
A pregnant patient of shows blood glucose levels of 50–55 mg/dL. The clinician is managing it with complex carbs and proteins, etc. There is no evidence of insulinoma, etc. Any suggestions?
Pregnant women may have lower acceptable average fasting glucose readings, and this may be physiologic. Hypoglycemia on CGM should always be confirmed with blood glucose readings and an appropriate evaluation performed if confirmed/recurrent diabetes. Remember, separate glycemic targets have been recommended for women with T1D during pregnancy and women with gestational and T2D during pregnancy.1
References
- Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603.
What is the role of CGM in the diagnosis of pre-diabetes?
There is currently no role for CGM in making a diagnosis of pre-diabetes. It can be used to determine glucose trends and responses to lifestyle interventions, but a diagnosis requires fasting serum glucose, oral glucose tolerance test, or HbA1c evaluation to be performed in a certified lab.
Can CGMs help kidney disease?
CGMs can benefit individuals with diabetes-related CKD by improving glycemic control, which can slow CKD progression and reduce complications such as cardiovascular disease. Among kidney transplant recipients, there is a high prevalence of hyperglycemia in the early post-transplant period and a high prevalence of post-transplant diabetes mellitus.1 CGMs also minimize the need for frequent finger sticks, which can be painful for dialysis patients with fragile skin. When setting glycemic targets for these high-risk patients, it is important to remember to focus on maintaining the time-in-range (70–180 mg/dL [3.9–10.0 mmol/L]) >50% and time-below-range (<70 mg/dL [3.9 mmol/L]) <1%.2
If you would like to learn more, please check out our interactive infographic by Dr. Wright, “Decoding the AGP for Personalized Diabetes Management,” here.
References
- Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603.
- Rhee CM, Gianchandani RY, Kerr D, et al. Consensus report on the use of continuous glucose monitoring in chronic kidney disease and diabetes. J Diabetes Sci Technol. 2025;19(1):217-245.
How accurate are the sensors?
Sensor accuracy is excellent. You can refer to the package insert for each CGM as to the specific accuracy of each device. Integrated CGM (iCGM) FDA-cleared systems with published performance data are established nonadjunctive and accurate CGM tools, allowing for insulin dosing without confirmatory finger stick.1
References
- Klonoff DC, Gabbay M, Moon SJ, Wilmot EG. Importance of FDA-integrated continuous glucose monitors to ensure accuracy of continuous glucose monitoring. J Diabetes Sci Technol. 2024:19322968241250357.
What substances could interfere with CGM accuracy?
Interfering substances vary by manufacturer, so it’s best to refer to the package inserts. Here is a guide to potential interfering substances by device:1-3
Device name | Potential interfering substances |
|---|---|
Abbott Freestyle Libre 2 | Ascorbic acid (vitamin C), >500 mg/day |
Abbott Freestyle Libre 3 | Ascorbic acid (vitamin C), >500 mg/day |
Abbott Freestyle Libre 14-Day | Ascorbic acid; salicylic acid |
Dexcom G6 | Hydroxyurea; high-dose acetaminophen (>4 g/day any dose) |
Dexcom G7 | Hydroxyurea |
Medtronic Guardian | Hydroxyurea; high-dose acetaminophen (>4 g/day any dose); alcohol |
Senseonics Eversense | Tetracycline; mannitol |
If you would like to learn more, please check out our interactive infographic by Dr. Green, “Who Should Get CGMs?,” here.
References
- Consumer guide: CGMs. American Diabetes Association website. https://consumerguide.diabetes.org/collections/cgm. Accessed February 12, 2025.
- Device library. DiabetesWisePro website. https://pro.diabeteswise.org/en/devices/device-library. Updated February 10, 2025. Accessed February 12, 2025.
- Consult QD. What to know in an expanding continuous glucose monitoring landscape. Cleveland Clinic website. https://consultqd.clevelandclinic.org/what-to-know-in-an-expanding-continuous-glucose-monitoring-landscape/. May 16, 2023. Accessed February 10, 2025.
