Question

Mary, 55 years old, was diagnosed with T2D 6 years ago. Presently she takes metformin, GLP-1 RA weekly, and basal insulin. She is interested in continuous glucose monitoring (CGM) devices and automated insulin delivery (AID) systems. Today, she presents to the pharmacy and indicates she would like to control her diabetes better but fears hypoglycemia and more injections. Which statement is true regarding CGM devices and AID systems that may be helpful for Mary before she sees the pharmacist?

a.
All CGM devices require fingerstick calibration twice daily using a standard blood glucose meter.
b.
Based on recent published data of hybrid closed-loop (HCL) systems, studies show ↓ low blood sugar, ↓ A1C, ↓ quality of life, and ↓ time in range.
c.
All Medicare patients must obtain their insulin pump and CGM supplies at a durable medical equipment supplier.
d.
Lower rates of severe hypoglycemia and diabetic ketoacidosis are seen with insulin pump therapy.

Answer 1

Answer: c.

Explanation:
- Medicare covers therapeutic CGMs and insulin pumps through Medicare-enrolled durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) suppliers, so beneficiaries must obtain these devices/supplies from such suppliers.
- a is false: most modern CGMs (e.g., Dexcom G6/G7, FreeStyle Libre) are factory calibrated and do not require twice-daily fingerstick calibration.
- b is false: hybrid closed‑loop systems reduce hypoglycemia and A1C and increase time in range and often improve quality of life (not decrease it).
- d is false: pumps generally reduce severe hypoglycemia risk versus MDI in many users, but pump therapy has been associated with equal or higher risk of DKA due to infusion set failures.