Sensing Inequity: How Students Can Expand CGM Access

Although the standard of care for diabetes has evolved significantly over the last couple of years, clinical practice has yet to catch up. The slow adoption of continuous glucose monitors (CGMs) into practice is a prime example of this delay. Despite being shown to lower hemoglobin A_1C (HbA_1C) and reduce the frequency of hypoglycemic events, CGMs still aren’t routinely used in practice.¹ The implementation of CGMs into patient management strategies has proved difficult and clinical implementation continues to lag behind evidence.¹

With an estimated 40.1 million people in the United States living with diabetes, strong intervention is critical.² Pharmacists and student pharmacists are among the most accessible health providers patients have, which puts them in a unique position to make changes in their patients’ care. By building knowledge of CGM barriers, pharmacists can start to close the care gap.

Why CGMs?

The American Diabetes Association (ADA) designates CGM use as integral to the management of type 1 diabetes and type 2 diabetes (T2D), for patients on insulin therapy.³ However, CGMs aren’t limited to insulin users; recent ADA guidelines now broaden CGM use to people managing T2D with glucose-lowering medications other than insulin, and most recently, have been made available over the counter for people seeking a better understanding of how their lifestyle affects their glucose levels.⁴

CGMs function by measuring glucose levels in interstitial fluid and provide constant feedback to users.⁵ This includes metrics such as time in range, glucose spikes, and hypoglycemic events. A user is able to see how diet, medication, and physical activity affect their glucose levels throughout the day. The clinical benefit is well-documented: When patients use a CGM alongside their diabetes regimen and act on the real-time feedback it provides, they can lower their HbA1C by approximately 0.5% to 0.9%, reduce glycemic variability, and reduce time spent in hyper- or hypoglycemic ranges.⁶ For providers, CGMs allow remote monitoring, making it easier for them to assess a patient’s status and create individualized therapy plans.

Beyond lab values, CGMs can also reduce patient burden. Although the need for fingerstick testing isn’t completely eliminated, CGMs can reduce the frequency of these tests. With the ability for real-time glucose monitoring, patients also have ease of mind, allowing for better medication adherence and less burnout.⁷ When used correctly, CGMs provide a sustainable method of managing diabetes, potentially reducing complications and lowering health care costs.

CGMs in Practice: The Utilization Gap

Despite the established data, a clear trend has appeared: CGMs are substantially underused. One study found that only 16.9% of insulin-using diabetes patients received a first-time CGM prescription from their primary care provider.⁷ That number is quite low, but the reasons behind it may not be easy to fix. Provider unfamiliarity with CGM technology, language barriers, and affordability all play a role in preventing patients from receiving optimal diabetes care.⁷

Barrier 1: Provider Awareness

Although CGMs are now recommended as standard protocol for diabetes management, delays in provider education and a lack of dedicated clinical infrastructure can prevent adequate integration of this technology into patient care.

Much of the issue with clinical integration lies with provider training. While patients who see endocrinologists or diabetes specialists are more likely to receive a CGM prescription, that access does not extend to the roughly 90% of patients whose diabetes is managed in primary care settings.⁸ For many individuals, seeing a specialist is not always possible or accessible, especially in rural areas. Primary care clinics are a key focus area: One study found that only 38.6% of primary care physicians have ever prescribed a CGM.⁹ This highlights the need for further provider training and awareness.

For complicated cases, this is where pharmacists and their students can play a huge role in initiation and follow-up:

• CGM screening: Pharmacists have access to a patient’s medication list.¹ While reviewing charts or conducting medication therapy management sessions, pharmacists can identify eligible patients for CGMs according to guidelines published by the ADA. This provides pharmacists with an opportunity to intervene and improve a patient’s experience, especially in an ambulatory care setting.
• Glucose monitoring: After a patient is prescribed a CGM, a pharmacist can participate in drug therapy monitoring. Pharmacists can track a patient’s glucose trends remotely, without even needing to see the patient in the clinic. Providers that engage with patients using CGMs should consider implementing remote patient monitoring platforms, which can improve patient outcomes and communication.

These potential interventions can help to increase CGM utilization, expand its benefits, and educate the broader interprofessional care team on the benefits of CGM prescribing.

Barrier 2: Racial and Ethnic Inequities

Another significant issue in CGM adoption is the persistence of racial and ethnic disparities in diabetes care. Although certain groups are disproportionately affected by diabetes, such as American Indian/Alaska Native and non-Hispanic Black populations, these minorities are actually the least likely to receive CGMs.^10,11 These inequities exist despite adequate insurance coverage.¹²

When comparing the absolute risk of CGM initiation among racial and ethnic groups among similar socioeconomic statuses (SES), White patients had consistently the highest odds of CGM initiation (0.26), compared to Asian (0.23), Black (0.21), Hispanic (0.13), and Native American (0.13) patients.¹³ Much of these disparities arise due to accessibility issues or perceived bias in the healthcare setting. This highlights the need for targeted interventions, to alleviate social barriers within CGM prescribing.

Pharmacy teams are well-positioned to help close this gap through several targeted strategies:

• Accessible language materials: Creating person centered care plans and evaluating a patient’s social determinants of health are core parts of the Pharmacist Patient Care Process.¹⁴ Pharmacists can notice language barriers when dispensing a CGM and source education materials in the languages their patient population actually speaks. Rather than defaulting to English-only handouts, pharmacy students can also research the options available for non-English speakers. This is a particularly valuable intervention in the community or ambulatory care setting, where pharmacists are often a patient’s most frequent point of contact. Providers should be familiar with the ADA’s Patient Education Library, which is available in eleven different languages.¹⁶
• Community partnerships: As a major community hub, pharmacists can greatly shift a patient’s perception of health care. By hosting community outreach events, such as diabetes screening days, and partnering with local organizations, pharmacists and student pharmacists can start to break down the distrust that has historically limited engagement with the healthcare system among underserved populations. These events provide opportunities for patient education on CGMs and encourage a more hands-on, autonomous approach to diabetes care.

Barrier 3: Socioeconomic Status and Insurance Struggles

Another roadblock to CGM integration into practice is cost. Across high, middle, and low SES groups, the odds of CGM initiation decrease significantly as SES declines.¹³ Costs add up quickly: without insurance, the average cost of CGM supplies can range from $100 to $300 a month.¹⁵ For patients of lower SES, these costs can be a major burden and a barrier to receiving appropriate care. Even with insurance, significant administrative hurdles remain. Some health plans require the submission of fingerstick glucose logs or completion of Certificate of Medical Necessity forms, which can often prevent patients from obtaining their prescribed CGM.¹

To help address these cost-related barriers, pharmacists and student pharmacists can pursue several strategies:

• Inpatient CGMs: The hospital setting is an underused opportunity for CGM use. These devices are increasingly being used as an adjunct for capillary blood glucose monitoring in inpatient settings, and the ADA has outlined how hospitals should begin developing protocols to support this shift. Hospital pharmacists can help drive this change by integrating CGMs into standard protocol when a patient is started on insulin. This can help to familiarize patients with the device so they can continue CGM use after discharge.¹
• Prior authorization requirements: Reducing the administrative burden of obtaining a CGM should also be a priority. With many insurance plans requiring prior authorization, patients often face delays in care and burnout from the approval process. Managed care pharmacists are well positioned to advocate for streamlined prior authorization criteria within their health plans, impacting large member populations across the country.¹²
• Manufacturer Patient Assistance Programs (PAPs): Pharmacists and student pharmacists in both ambulatory and community settings should be familiar with PAPs offered by CGM manufacturers. For example, Abbott offers a copay card for its FreeStyle Libre systems, whereas Dexcom offers its own PAP. Pharmacists should understand these programs and consistently offer them to eligible patients.¹²

Where Student Pharmacists Fit In

Student pharmacists are a vital part of the interprofessional care team, and every barrier discussed above offers a natural entry point for their involvement. Whether on rotation in a community, ambulatory, or hospital setting, students are often the ones with the most direct patient contact and the flexibility to follow up in ways busy providers cannot. They can screen charts to identify CGM-eligible patients, help translate or source non-English educational materials, support hospital pharmacists piloting inpatient CGM protocols, or guide patients through manufacturer PAPs.

It is also important to recognize trusted sources that can build knowledge on new technologies, such as the ADA’s Institute of Learning for diabetes focused topics or other accredited professional development courses. By combining continuing education learning with real clinical interactions, students can become confident, competent providers who are prepared to translate evolving evidence into safe, patient-centered care throughout their careers.

REFERENCES

1. Rickards GM, Harrod JC, Del Valle K, et al. Addressing inequity in continuous glucose monitoring access: leveraging the hospital in the continuum of care. J Diabetes Sci Technol. 2024;20(1):220-226. doi:10.1177/19322968241288917

2. National diabetes statistics report. News release. CDC. January 21, 2026. Accessed August 5, 2026. https://www.cdc.gov/diabetes/php/data-research/index.html

3. American Diabetes Association Professional Practice Committee for Diabetes; 7. Diabetes technology: standards of care in diabetes—2026. Diabetes Care. 2026;49(Supplement_1):S150–S165. doi:10.2337/dc26-S007

4. Powell J, Mulani SR. Partnering for better health: using continuous glucose monitoring and clinical pharmacist collaboration to improve glycemic control in underserved patients with type 2 diabetes. Clin Ther. 2024;46(1):e7-e11. doi:10.1016/j.clinthera.2023.10.005

5. Lee JY, Arcos D, Chan D, Karabedian C, Mayorga J. Pharmacy students' perceptions of receiving hands-on continuous glucose monitoring (CGM) education as part of their core curriculum: a pre-post study. Pharmacy (Basel). 2025;13(3):78. doi:10.3390/pharmacy13030078

6. Norman GJ, Fernandes J, Nemlekar P, et al. Initiating continuous glucose monitoring is associated with improvements in glycemic control and reduced health care resource utilization for people with diabetes in a large US-insured population: A real-world evidence study. J Manag Care Spec Pharm. 2024;31(1):15-24. doi:10.18553/jmcp.2024.24255

7. Milosavljevic J, Schechter C, Fazzari M, et al. Inequity in continuous glucose monitor (CGM) prescribing behaviors in primary care. J Gen Intern Med. 2026;1-8. doi:10.1007/s11606-025-09923-7

8. Oser TK, Hall TL, Dickinson M, et al. Continuous glucose monitoring in primary care: understanding and supporting clinicians' use to enhance diabetes care. Ann Fam Med. 2022;20(6):541-547. doi:10.1370/afm.2876

9. Runyon AM, Koran-Scholl JB. The impact of a hands-on workshop on continuous glucose monitor prescribing in a family medicine residency. PRiMER. 2025;9:60. doi:10.22454/PRiMER.2025.940150

10. Cellino ACK, Chen E, Pawelek J, et al. Pharmacist's role in addressing barriers to continuous glucose monitoring within underserved communities. J Am Pharm Assoc. 2026;66(2):103016. doi:10.1016/j.japh.2025.103016

11. Alkabbani W, Cromer SJ, Kim D, et al. Overall uptake and racial, ethnic, and socioeconomic disparities in the use of continuous glucose monitoring devices among insulin-treated older adults with type 2 diabetes. Diabetes Care. 2025;48(8):1377-1385. doi:10.2337/dca25-0006.

12. Ebekozien O. Roadmap to achieving continuous glucose monitoring equity: insights from the T1D exchange quality improvement collaborative. Diabetes Spectr. 2023;36(4):320–326. doi:10.2337/dsi23-0002

13. Alkabbani W, Cromer SJ, Kim D, et al. Overall uptake and racial, ethnic, and socioeconomic disparities in the use of continuous glucose monitoring devices among insulin-treated older adults with type 2 diabetes. Diabetes Care. 2025;48(8):1377-1385. doi:10.2337/dca25-0006

14. The pharmacists' patient care process. Updated May 20, 2025. Joint Commission of Pharmacy Practitioners. Accessed August 5, 2026. https://jcpp.net/patient-care-process/

15. Watson AM. How much does a continuous glucose monitor cost and will insurance pay for it? Updated August 26, 2024. Accessed August 5, 2026. https://www.goodrx.com/conditions/diabetes/continuous-glucose-monitor-cost

16. Patient education library. American Diabetes Association. Accessed August 18, 2026. https://professional.diabetes.org/diabetes-support-resources