CGM and Ketone Data Reshape Pharmacist-Led Diabetes Care: Insights From NEIAP 2026

Continuous glucose monitoring (CGM) can turn a patient who refuses medication into a “super responder,” and pharmacists are positioned to lead that shift, according to Jennifer Goldman, PharmD, CDCES, BC-ADM, FCCP, professor of pharmacy practice at Massachusetts College of Pharmacy and director of cardiometabolic services at WellLife Medical in Peabody, Massachusetts. Speaking at the New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum in Boston, Massachusetts, Goldman argued that reading CGM patterns, spotting risk, and preparing patients for emerging continuous ketone monitoring all fall squarely within the pharmacist's scope.¹

Data as a Behavior-Change Tool

Goldman opened with a 74-year-old patient who had type 2 diabetes for more than a decade, established coronary artery disease, chronic kidney disease, and an hemoglobin A1_C stuck at 11.7%—unchanged from 2011 to 2026. The patient refused medication changes but agreed to wear a CGM.¹

The results reframed the visit. Time in range climbed from 3% in the first week to 39% two weeks later and to 95% roughly a month after starting semaglutide (Ozempic, Wegovy; Novo Nordisk), according to Goldman. She credited the sensor itself, not just the drug.

“Data is power,” Goldman said, describing how the patient began checking her glucose 30, 40, or 50 times a day and adjusting what she ate. Improved control, Goldman noted, was what finally cleared the patient for long-denied cataract and knee surgeries.¹

“She’s looking at that data and saying, ‘Wow, when I eat this, what’s happening?’” Goldman highlighted. “Then, it gives me the opportunity to say, ‘Now let’s look at your kidneys. Now let’s look at your cardiovascular risk. Because this isn’t going to kill you, but [cardiovascular risk] will.’”¹

A second patient—a man Goldman has treated for 20 years—moved from approximately 41% to 80% time in range on semaglutide, with a glucose management indicator of 7.1%, allowing her to discontinue his insulin. She framed both cases as evidence that access should not be a barrier. “Just like I feel like with obesity medications, it should be a right, not a privilege. That's how I feel about CGM,” Goldman said, noting the sensor was not covered because the patient was not on insulin.¹

Preparing for Continuous Ketone Monitoring

Goldman then turned to the FDA’s authorization of Abbott's Libre Duo 10 Day, the first system to continuously monitor both glucose and ketones, cleared for people aged 2 years and older. The device received De Novo authorization on August 25, 2026, with a US launch planned later in the year.^1,2

She stressed that the field is not ready. Citing survey data she presented, Goldman said roughly 1 in 3 adults with type 1 diabetes (T1D) treated at specialized centers were unfamiliar with the term diabetic ketoacidosis (DKA), 46% could not name a single symptom, 64% reported never testing ketones, and only 18% had a home ketone monitor.¹

“Ketones can be present before symptoms appear, even when glucose is not high,” Goldman explained. “What we can do is screen for that when they’re in front of us and ask for these screens.”¹

The Sick-Day Plan Pharmacists Can Own

Because ketones can rise before glucose climbs—and euglycemic DKA can occur at near-normal glucose, particularly with sodium-glucose cotransporter 2 (SGLT2) inhibitors—Goldman urged pharmacists to build and rehearse sick-day plans now. She referenced international guidance tiering beta-hydroxybutyrate: below 0.6 mmol/L requires no action; 0.6 to 1.5 mmol/L triggers a sick-day plan; 1.5 to under 3.0 mmol/L means contacting the care team; and above 3.0 mmol/L is an emergency.^1,3

Practical counseling points followed: Do not stop basal insulin during illness even when not eating, hold SGLT2 inhibitors when sick, and get patients to the emergency department when DKA is possible.¹

“If DKA is possible, they have to go to the emergency room,” Goldman emphasized; a patient cannot simply be sent home to wait and hopefully feel better.¹

Goldman flagged open questions the new class of devices will need to answer—alert-workflow capacity, cost and coverage, pump integration, and which highest-risk patients should receive the technology first, including those on insulin pumps, people with recurrent DKA, and pregnant patients with T1D.¹

"Read a pattern of CGM, recognize the risk, and identify those patients," Goldman said in closing, predicting pharmacists "will [continue to] be a big driver of the use of CGM."¹

REFERENCES

1. Goldman J. Supporting Diabetes Management with CGM and CKM: A Pharmacist-Focused Approach. Presented at: New England Institute of Ambulatory Care Pharmacists (NEIAP) 2026 Annual Forum; September 11, 2026; Boston, MA.

2. Halpern L. FDA clears first continuous glucose-ketone monitor. Pharmacy Times. August 25, 2026. Accessed September 14, 2026. https://www.pharmacytimes.com/view/fda-clears-first-continuous-glucose-ketone-monitor

3. Danne T, Garg S, Peters AL, et al. International consensus on risk management of diabetic ketoacidosis in patients with type 1 diabetes treated with sodium-glucose cotransporter (SGLT) inhibitors. Diabetes Care. 2019;42(6):1147-1154. doi:10.2337/dc18-2316