Natalie Bellini, DNP, FNP-BC, BC-ADM, explains why continuous glucose monitor (CGM) persistence so often breaks down after initiation and how pharmacists can intervene at the point of dispensing.
In an interview with Pharmacy Times for the 2026 Diabetes Day of Education, Natalie Bellini, DNP, FNP-BC, BC-ADM, assistant professor of medicine and program director of diabetes technology at Case Western Reserve University/University Hospitals, discussed the most common barriers patients face when using continuous glucose monitors (CGMs).
Bellini emphasized that patients are frequently sent home with CGMs without adequate instruction on application or skin preparation, leading to early device abandonment. She identified 2 primary reasons for poor long-term CGM persistence: sensors falling off due to insufficient education on adhesion strategies and patients never having their CGM data reviewed or explained. Bellini stressed that meaningful engagement with CGM reports—identifying patterns tied to daily behaviors like exercise or diet—is essential to helping patients understand the value of the technology and sustain its use.
Pharmacy Times: What are the most common questions or misconceptions patients bring to the pharmacy counter about their CGM?
Natalie Bellini, DNP, FNP-BC, BC-ADM: Probably one of the most common questions is, “How do I put it on?” If they were prescribed a CGM and not given a sample and no one talked to them about it, they’ll show up and say, “Here’s my little box. Now what?” I think a pharmacist in the community setting needs to be trained and needs to know, just like you need to know how to take a prescription medicine that needs to be taken with food, without food, or on an empty stomach. They need to know how to put this on. If you’re going to dispense a CGM and send them home with it and hope that they do it, they’re not going to do it, or most of them won’t do it, and then they’re never going to come back and they will not wear it. The benefit only comes with the data.
Pharmacy Times: Where does the breakdown in long-term CGM persistence most often happen after initiation?
Bellini: I think there are 2 challenges with long-term adoption. One, the person can’t keep them on their bodies. They fall off, they don’t know what to do, and the education hasn’t been put in place to say, “These are the ways we keep these on,” because if they fall off, they don’t work. If it’s a 15-day sensor, for example, and it falls off on day 6 and you haven’t been taught to call the company or how to prep the skin ahead of time, the person doesn’t see that as a benefit. It becomes more of a frustration. We need to get the education in ahead of time about how to keep them on and functioning well. That’s the first reason.
The second reason is that nobody looks at the data. With a continuous glucose sensor, we’re looking minute by minute. I can look at it and say, “Is this person 126 and steady? Going up? Going down? What’s the pattern? What’s happening?” We can look at speed and direction of change. When no one has looked at the data and identified patterns, I think that’s where we see the biggest drop-off. When people with diabetes or prediabetes come in—even if they’re using an over-the-counter CGM—we always print that report and show it to them. I ask every time, “Have you ever seen one of these?” Their answer? “Absolutely not.” It’s been created in a cloud, and they’ve never been shown what it is and what it does. Then we can peel back that layer and say [the following]:
“Okay, this is what this says. This is what this means. Look, Tuesdays you’re in range almost 100% of the time.”
“Oh, Tuesday is the day I have my grandchildren.”
“Oh, you must get more exercise because you’re chasing them around.”
“Oh yes, that’s what I do.”
Then we might say, “Fridays you run a little bit higher. Can we talk about that?”
“Oh, Friday’s ‘Friday night out.’”
Okay, how do we change medication or behavior around Fridays? I’m not saying don’t go out on Friday. What I’m saying is, if they’re on insulin, maybe give a little more. If they’re on fixed-dose medications like a once-weekly glucagon-like peptide-1 and metformin, maybe go for a walk after dinner or change dietary choices at dinner. There are lots of different ways we can do this, but those are the 2 big ones: it falls off when they don’t know what to do, or no one has ever helped them look at the data to understand why we’re doing what we’re doing.
