
Continuous glucose monitors (CGMs) are revolutionizing diabetes management. These compact devices continuously measure blood sugar, providing near-instant data via phone, offering the potential to significantly improve quality of life for 537 million adults living with diabetes worldwide.
Yet, for many, CGMs remain out of reach. The growing popularity among consumers who use them as a lifestyle tool, not to manage diabetes, is exacerbating existing health inequities. It’s a tale similar to that of weight loss drugs, such as Ozempic, where those who need them most are usually those who have the hardest time getting access.
The Rise of CGMs as a Technological Phenomenon
Unlike traditional blood glucose meters, which require manually extracting blood multiple times daily, CGMs seamlessly and continuously monitor glucose levels. When used properly, accuracy is usually between 96.5 percent and 99.1 percent.
The growing popularity [of continuous glucose monitors (CGMs)]…as a lifestyle tool, not to manage diabetes, is exacerbating existing health inequities.
CGMs usually look like small plastic coins with a sensor wired through the device. They are typically embedded in a user’s arm through a surprisingly painless and straightforward process and are connected through Bluetooth to a CGM tracking app on their phone.
When the user is nearing a low- or high-blood-sugar level, the CGM apps send critical alerts to their phone. These alerts can be the difference between preventing a very dangerous blood sugar event and the need for hospital intervention.
But CGMs aren’t just useful tools for early detection of blood sugar issues. They’re also vital for prevention—by providing detailed, real-time information to their users, CGMs serve as educational tools for patients about managing and mitigating their disease in the long-term.
Studies have shown that those who use CGMs are 40 percent more likely to lose weight and can reduce their average blood sugar levels by 30 percent compared to those who rely solely on traditional diabetes management methods. The insights users gain from using a CGM can have lasting benefits long after they stop using the device too.
Strict Medicaid coverage rules can render CGMs inaccessible to people living with diabetes.
One key advantage of a CGM is its ability to help people understand how specific foods, ingredient combinations, and meal timing can impact blood sugar levels.
Consistently logging and monitoring these variables can reveal correlations between dietary choices and blood sugar responses. This enables more-informed decisions about diet and lifestyle, leading to better blood sugar management over time.
The Luxury Most Can’t Afford
Despite their benefits, CGMs are not accessible to those who need them most. Without insurance coverage, the devices typically cost between $100 and $300 and require replacement every 10 to 14 days, adding up to a significant recurring expense.
For many people with diabetes, particularly those living below the poverty line, the cost of CGMs makes them unattainable. In the United States, the prevalence of diabetes is highest among low-income populations.
People with diabetes are more than twice as likely to receive healthcare coverage from Medicaid as those without diabetes. Yet, strict Medicaid coverage rules can render CGMs inaccessible to people living with diabetes. Some states only offer coverage for type 1 diabetes (also known as juvenile diabetes), and some offer no coverage at all.
People with diabetes who are on Medicaid, particularly people of color, are least likely to use a CGM. Even those with access to employer healthcare benefits can pay up to $75 monthly for CGM access.
Meanwhile, over the last few years, companies like ZOE and Oviva have been marketing CGMs as trendy, health-optimization tools for people who don’t have diabetes. Influencers have taken to social media to promote these devices, which monitor and optimize blood sugar levels to help with weight loss, improve athletic performance, or decrease tiredness.
While these uses of CGMs may have merit, this trend has transformed their reputation from critical medical devices into lifestyle gadgets.
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The rebranding is problematic for several reasons.
First, it dilutes the perception of CGMs as necessary medical tools for people with diabetes, potentially reducing the urgency of making these devices accessible to those who need them most.
Second, it drives up demand—and consequently, prices—for CGMs, making them even less affordable for living on low incomes and managing diabetes. While some CGM companies have lowered their prices to expand their market share, prices generally remain high. This may be because CGM producers have access to this lucrative private market.
Finally, it perpetuates a troubling trend in the wellness industry, where expensive technologies create a divide between those who can afford the latest gadgets and those who cannot. The same pattern has played out with weight loss drugs and the inability of people living with diabetes to access them.
These developments underscore a broader issue of deepening health inequities. As access to advanced healthcare technologies becomes increasingly linked to socioeconomic status, those who cannot afford these tools are left behind.
Policymakers must consider the broader implications of allowing advanced healthcare technologies to become luxury items.
Advocating for Change
Public policy solutions are necessary to narrow the healthcare gap. Governments and healthcare providers must recognize the potential for CGMs to improve diabetes outcomes and take the steps required to make them more accessible for everyone.
This should first involve expanding Medicaid access to CGMs for all people living with diabetes and pre-diabetes without stipulations. Depending on the state, a Medicaid program may require multiple glucose tests to be taken daily or being on insulin for at least six months while using a pump to prove eligibility. The glaring issue here is that the diabetes condition must be quite severe to prove eligibility; at that point it’s much more challenging to reverse or improve.
CGM producers can also partner with medical professionals, rather than health-tech startups. By offering easier access through e-commerce pharmacies, accessibility will improve for those unable to easily access a physician’s office.
Policymakers must consider the broader implications of allowing advanced healthcare technologies to become luxury items. The cost of managing chronic conditions like diabetes continues to rise, increasing the economic burden on individuals and the healthcare system.
The annual cost of diabetes in the United States is estimated at $413 billion. Making CGMs more accessible would not only improve health outcomes for people with diabetes but also reduce the long-term, widespread costs associated with managing the disease. Moreover, because CGMs alleviate complications associated with the disease, their cost-saving potential extends beyond diabetes alone.
Home blood pressure monitors (HBPMs) illustrate how initiatives to improve healthcare technology access have been successful. While they were once expensive and inaccessible, HBPMs are up to 90 percent cheaper than when OMRON launched the first-ever model.
Basic models are now available for $20 and can last years before needing replacement. These devices offer huge health benefits. In general, only 30 percent of patients with high blood pressure tend to keep their condition under control, but regular home monitoring makes managing high blood pressure much easier, reducing the risk of serious complications like organ damage, cardiovascular disease, and strokes.
The democratization of HBPMs has even been good for manufacturers. The devices are forecast to grow across international markets over the next five years. Although Medicare doesn’t fully cover HBPMs (except in specific cases like home dialysis), Medicaid coverage has expanded, with 84 percent of all states reimbursing home blood pressure monitoring services.
The HBPM trajectory shows that CGMs can become more accessible, as long corporations don’t co-opt them for profit as diet-culture devices rather than life-saving tools. To do this, we must first address cost barriers through advocacy and reframe the narrative around these devices.
The focus should be on getting CGMs into the hands of those who need them most: people living with diabetes—especially those with economic barriers to accessing treatment—not healthy people succumbing to the allure of the next wellness trend.