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I recently learned exciting news that I felt was important to share with the type2diabetes.com community. As of January 12th, 2017, the Centers for Medicare and Medicaid Services (CMS) has classified continuous glucose monitors as “Durable Medical Equipment” (DME) under Medicare Part B (Medicare Part B covers various services, one of which includes DME). The Dexcom G 5 Mobile System is the only continuous glucose monitoring system that currently meets criteria to be classified, according to CMS, as “durable medical equipment”.

What is a Continuous Glucose Monitor (CGM)?

A continuous glucose monitor (CGM) is a small electronic device that measures glucose levels in the interstitial fluid (the fluid that surrounds body cells). There are three main parts to a CGM:

  • A Sensor: A sensor is a small metallic fiber that is inserted just underneath the skin with the assistance of a mechanical insertion device.
  • A Transmitter: The transmitter is a small piece that is connected to the top of the sensor. Once connected (and after a 2 hour “warm up” period), the transmitter takes glucose data from the sensor and wirelessly sends it to the display device.
  • A Display Device: The display device can be a compatible smart device (with the Dexcom G5 mobile app) or the Dexcom G5 mobile receiver. The display device(s) shows glucose readings every 5 minutes and shows the direction glucose is heading, the rate at which glucose is changing (rate of change arrows).

Why is the CMS’s ruling so exiting?

Prior to CMS’s ruling, continuous glucose monitors were not a covered benefit. Meaning if you wanted to use/wear a CGM, you would have to pay for it 100 percent out of pocket. “Dexcom will now work with CMS over ‘the coming months’ to implement coverage, enabling those on Medicare to finally get CGM reimbursed”.1

Why the change?

In December 2016, the U.S. Food and Drug Administration (FDA) approved the use of Dexcom’s Mobile G5 CGM for treatment decisions. “Under the new CMS ruling, CGM’s that are FDA-approved for making diabetes treatment decisions (e.g., dosing insulin) finally have a pathway to Medicare reimbursement”.1

How can wearing a CGM improve diabetes control?

Research has shown that those who regularly wear a CGM gain the most benefit, which includes:

Who should consider wearing a CGM?

While many can benefit from a CGM, people who may find a CGM especially beneficial include:

  • Those with a history of severe hypoglycemia, hypoglycemia unawareness, and/or nocturnal hypoglycemia
  • Those that are pregnant, elderly, or athletes
  • Patients newly diagnosed with type 2 diabetes may use CGM to learn how their glucose responds to various forms of food and physical activity.3
view references
  1. Gao, H., Kennedy, L., & Brown, A. (2017, January 28). CMS announces critical First step toward medicare coverage of CGM. Retrieved February 25, 2017, from diaTribe, https://diatribe.org/cms-announces-critical-first-step-toward-medicare-coverage-cgm
  2. Pettus, J., & Edelman, S. V. (2016). Recommendations for using real-time continuous glucose monitoring (rtCGM) data for insulin adjustments in type 1 diabetes.Journal of Diabetes Science and Technology11(1), 138–147. doi:10.1177/1932296816663747
  3. Practice Papers. (2015). Retrieved February 25, 2017, from American Association of Diabetes Educators, https://www.diabeteseducator.org/docs/default-source/default-document-library/aade-2015-cgm-summit-white-paper-final.pdf?sfvrsn=0
  4. FDA expands indication for continuous glucose monitoring system, first to replace fingerstick testing for diabetes treatment decisions. (2016, December 22). Retrieved February 25, 2017, from U.S. Food and Drug Administration, https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm534056.htm
  5. Centers for medicare & Medicaid services (CMS) classify therapeutic continuous glucose monitors (CGM) as “durable medical equipment” under medicare part B. (2017, January 13). Retrieved February 25, 2017, from Dexcom, https://www.dexcom.com/news/dexcom-cgm-medicare
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