Key CGM Updates and Highlights From the 2025 Standards of Care in Diabetes Revision by the ADA

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Hello, everyone. My name is Jennifer Green, and I’m an endocrinologist and professor of medicine at Duke University in Durham, North Carolina. I’d like to welcome you to this independent medical education program on continuous glucose monitoring, or CGM, device updates, where we’ll share with you a couple of exciting updates to the 2025 American Diabetes Association’s Standards of Care in Diabetes.1 

[00:33.4] 

While there were many intriguing updates this year, I’ll focus on just a few key updates in particular, which I feel will impact your practice the most. These changes include modifications to guidance regarding the types of individuals with diabetes who may benefit from use of CGM as part of their care, how CGM data should be provided to CGM users and their care team, and how CGM may fit into the broader plan of care for individuals with both prediabetes and diabetes. 

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One recommendation has been changed to emphasize that providers consider prescribing diabetes technology, including CGM therapy, at early stages, including at the time of diabetes diagnosis, in individuals who will require insulin therapy. 

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Such an approach reduces the burden of blood glucose testing and can be used to guide both medical and non-medical, such as lifestyle modification. To facilitate the choice of appropriate technology, the ADA provides an online diabetes technology guide, which can be found at [https://diabetes.org/living-with-diabetes/treatment-care/diabetes-technology-guide]2, which can help individuals with diabetes and their providers decide which devices may be best for them. 

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Of course, use of CGM devices is most meaningful and effective when the CGM data are reviewed regularly and acted upon. The ADA has strengthened recommendations to that effect but also notes that the review of data should be made less burdensome through the provision of standardized and streamlined CGM reports. 

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They recommend that the reports should be both straightforward and comprehensive, and follow a predictable outline, including the frequency and adequacy of glucose data collection, as well as hypo- and hyperglycemia trends, in order to optimally use the data to guide medication management. This will permit effective treatment modifications in essentially real-time during an office visit3.  

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The ADA also now suggests that we consider combining diabetes technology, including CGM, along with digital health solutions to improve glycemia in people with diabetes and prediabetes. 

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Such programs may focus upon proven diabetes prevention modalities such as those used in the Diabetes Prevention Program, and may combine glucose and other monitoring data to provide lifestyle coaching and feedback for people with prediabetes and diabetes. 

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Although data regarding the efficacy of such programs is preliminary, these virtual support programs may be beneficial for some individuals. So far, observational real-world data suggest that engagement with such a program at least once per week may improve glycemic control in people with Type 2 diabetes.4 

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Evidence continues to build to support the use of CGM in adults and children with Type 1 or Type 2 diabetes who were using any type of insulin therapy to manage hyperglycemia. But notably, the ADA now also recommends considering use of CGM to aid in the achievement of glycemic targets in adults with Type 2 diabetes treated with diabetes medicines other than insulin. 

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In support of this recommendation, one recent clinical trial was highlighted, which found that in such patients, use of CGM plus diabetes education was more effective in lowering A1C and increasing time in target glucose range, as well as time in tight range, that is glucoses between 70 and 140 milligrams per deciliter, when compared to diabetes education alone.5 

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In addition, a systematic review and meta-analysis of trials assessing the efficacy of CGM use in non-insulin-treated people with Type 2 diabetes was also published in 2024. The analysis included six trials enrolling over 400 non-insulin-treated people who had had type 2 diabetes between about 5 to 14 years, who had an average age of about 58, and a body mass index of 30.8. 

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The CGM devices used in the studies included those which provided real-time glucose data and intermittently scanned devices. The investigators found that when compared to self-monitoring of glucose via finger-stick testing, randomization to CGM use significantly reduced hemoglobin A1C, the time spent in hypoglycemia level 2, that is, with a glucose less than 54 milligrams per deciliter, and time with glucose greater than 180 milligrams per deciliter. 

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CGM use also importantly increased the time spent in target glucose range between 70 to 180 milligrams per deciliter, it reduced overall glucose variability, and was associated with increased treatment satisfaction.6 

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And finally, the ADA notes that CGM use is helpful in achieving glycemic goals in women with Type 1 diabetes and pregnancy and may also be helpful during pregnancy in women with other types of diabetes. 

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In women with Type 1 diabetes and pregnancy, the use of CGM has been found to reduce the risk of large-for-gestational-age infants, neonatal hypoglycemia and the likelihood of neonatal intensive care unit admission. 

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Of course, tighter glycemic goals are recommended in order to improve these pregnancy-related outcomes. A recent international consensus on glycemic targets in women with diabetes and pregnancy has suggested treatment goals of greater than 70% time in pregnancy target range between 63 and 140 milligrams per deciliter, with no more than 25% of time spent above that range, and no more than 4% time below that range.7 

[07:38.0] 

Guidelines currently in use in the United Kingdom suggest that CGM should be offered to all women with Type 1 diabetes and pregnancy. CGM should also be considered for use in pregnant women without Type 1 diabetes who require insulin, particularly if they have unstable hyperglycemia or problematic severe hypoglycemia. 

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Use of CGM during pregnancy in women with type 2 diabetes may result in even greater improvement in glycemia than that seen in women with Type 1 diabetes. However, as little data are available regarding the benefits of CGM use in women with Type 2 diabetes or gestational diabetes, the therapy is not yet universally recommended.8 

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In summary, the revised ADA Standards of Care reflect the benefits of CGM use in ever broader populations of people with or at risk for diabetes. Use of CGM to improve glycemia and other outcomes should be considered at or even before the time of diabetes diagnosis and during pregnancy with diabetes. 

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Of course, in order for CGM use to provide a benefit, the captured glycemic data must be readily accessible and analyzable via standardized reports In addition, incorporation of virtual support programs may help to translate CGM data into effective personalized recommendations for care. 

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Thanks for listening to this podcast update. There are a number of available resources to help clinicians and practices get started using CGM in their practice. I hope you check out Springer Healthcare IME’s CME-accredited interactive infographics and tutorials where I, along with Dr. Rosalina McCoy and Dr. Eugene Wright, dive deeper into the most important considerations for CGM use in primary care. 

REFERENCES 

1. American Diabetes Association Professional Practice Committee. 7. Diabetes technology: standards of care in diabetes – 2025. Diabetes Care. 2025;48(Suppl 1):S146-S166. doi: 10.2337/dc25-S007 
2. American Diabetes Association. Life with diabetes: diabetes technology guide. Accessed March 6, 2025. https://diabetes.org/living-with-diabetes/treatment-care/diabetes-technology-guide 
3. Phillip M, Nimri R, Bergenstal RM, et al. Consensus recommendations for the use of automated insulin delivery technologies in clinical practice. Endocr Rev. 2023;44(2):254-280. doi: 10.1210/endrev/bnac022 
4. Kumbara AB, Iyer AK, Green CR, et al. Impact of a combined continuous glucose monitoring–digital health solution on glucose metrics and self-management behavior for adults with type 2 diabetes: real-world, observational study. JMIR Diabetes. September 2023;8:e47638. doi: 10.2196/47638 
5. Aronson R, Brown RE, Chu L, et al. IMpact of flash glucose Monitoring in pEople with type 2 Diabetes Inadequately controlled with non-insulin Antihyperglycaemic ThErapy (IMMEDIATE): a randomized controlled trial. Diabetes Obes Metab. 2023;25(4):1024-1031. doi: 10.1111/dom.14949 
6. 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 
7. 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. doi: 10.2337/dci19-0028 
8. Yamamoto JM, Murphy HR. Benefits of real-time continuous glucose monitoring in pregnancy. Diabetes Technol Ther. 2021;23(S1):S8-S14. doi: 10.1089/dia.2020.0667