Revolutionizing Diabetes Care with Advanced CGM Devices

February 07, 2024 - Continuous glucose monitoring (CGM) devices have transformed diabetes management by enabling continuous and accurate real-time tracking of blood glucose levels. These minimally invasive wearables eliminate the need for frequent fingerstick testing and play a vital role in effective chronic condition management for individuals with diabetes, prediabetes, or gestational diabetes.

By continuously monitoring glucose levels throughout the day and night, CGMs provide real-time data and trends to help people make informed treatment decisions.

In the United States, several brands of CGMs are available, each with varying levels of reliability and accuracy. The choice of the most suitable brand often depends on factors such as personal preference, ease of use, cost, and insurance coverage.

Personal CGM Devices

Personal CGM devices are wearable devices used by individuals with diabetes to monitor their blood glucose levels continuously. They consist of a sensor inserted under the skin. This transmitter sends data wirelessly to a receiver or smartphone app and provides real-time glucose readings, trend analyses, and customizable alarms. They help users make informed decisions about their diabetes management and improve glycemic control.

Personal FDA-approved CGM devices include Abbott’s FreeStyle Libre 2 and 3, Dexcom’s G6 and G7, Medtronic Diabetes’ Guardian Connect, and Senseonics’ Eversense E3.

Abbott FreeStyle Libre 2

The FreeStyle Libre 2 is a CGM system developed by Abbott that measures glucose levels in interstitial fluid (ISF), providing real-time data to the user. The sensor communicates wirelessly with a reader or compatible smartphone and features customizable high- and low-glucose alerts, helping users manage their diabetes more effectively.

FDA Approval Date: June 12, 2020
Glucose Reading Frequency: measures every min; records every 15 min
Sensor Placement: back of the upper arm
Sensor Size: 1.38 × 0.2 in.
Approved Ages: 2 and older
Cost: retails around $154 for two 14-day sensors
Sensor Duration: 14 days
Waterproof (up to 3.2 ft): 30 min
Data Sharing: up to 20 people
Transmitter Range: 20 ft
Calibration: not required
Warm-up Time: 1 h
Overall MARD: 9.2% for adults; 9.7% for children
Device Compatibility: certain Apple iOS and Android devices

Abbott FreeStyle Libre 3

Libre 3’s smaller size and matte finish offer enhanced comfort and minimized visibility. Unlike previous models, it holds data for longer periods, reducing the need for frequent scans. This innovation provides users instant access to glucose readings, offering more timely updates for improved diabetes management.

FDA Approval Date: May 26, 2022
Glucose Reading Frequency: every min
Sensor Placement: back of the upper arm
Sensor Size: 0.1 × 0.8 in.
Approved Ages: 4 and older
Cost: retails around $154 for two 14-day sensors
Sensor Duration: 14 days
Waterproof (up to 3.2 ft): 30 min
Data Sharing: up to 20 people
Transmitter Range: 33 ft
Calibration: not required
Warm-up Time: 1 h
Overall MARD: 7.9%
Device Compatibility: specified Apple iOS and Android devices

Dexcom G6

The Dexcom G6 is a CGM system that measures glucose levels in ISF. The sensor communicates wirelessly with a receiver or compatible smartphone, providing real-time glucose readings. It also features customizable high- and low-glucose alerts, trend arrows indicating the direction and rate of glucose change, and the ability to remotely share data with caregivers or healthcare providers. Unlike other CGM systems, Decom's sensors require an overpatch.

FDA Approval Date: March 27, 2018
Glucose Reading Frequency: every 5 min
Sensor Placement: abdomen (ages 2 and older) or upper buttocks (ages 2–17 years)
Sensor Size: 1.8 × 1.2 × 0.6 in.
Approved Ages: 2 years and older
Cost: retails around $450 for three 10-day sensors
Sensor Duration: 10 days
Waterproof (up to 8 ft): 24 h
Data Sharing: up to 10 people
Transmitter Range: 20 ft
Calibration: not required but advised
Warm-up Time: 2 h
Overall MARD: 9.0%
Device Compatibility: specified Android and iOS devices, Dexcom receiver, Tubeless Omnipod 5 Automated Insulin Delivery System, Tandem t:slim X2 insulin pump, iLet Bionic Pancreas, Lily Tempo, and various third-party healthcare apps

Dexcom G7

Dexcom G7 offers several improvements over previous models, including a smaller, more discreet design, a longer wear duration of up to 14 days, and a simplified sensor insertion process.

FDA Approval Date: December 7, 2022
Glucose Reading Frequency: every 5 min
Sensor Placement: back of the upper arm, abdomen (except during pregnancy), or upper buttocks (ages 2–6 only)
Sensor Size: 1.07 × 0.94 × 0.18 in.
Approved Ages: 2 years and older
Cost: retails for $150 per 10-day sensor
Sensor Duration: 10 days + 12 h grace period
Waterproof (up to 8 ft): 24 h
Data Sharing: up to 10 people
Transmitter Range: 20 ft
Calibration: not required
Warm-up Time: 30 min
Overall MARD: 8.2% for adults; 8.1% for children
Device Compatibility: the latest Apple iOS and Android devices; Beta Bionics iLet, Tandem t:slim X2 insulin pump, Lily Tempo

Medtronic Guardian Connect

Medtronic Diabetes developed the Guardian Connect CGM system that includes a small sensor, Guardian Sensor 3, that is inserted under the skin to measure glucose levels in ISF. The sensor communicates wirelessly with a compatible smartphone, allowing users to view their glucose readings in real time through a dedicated mobile app.

Guardian Connect gives users insights into their glucose trends, including rate of change and predictive alerts for high- and low-glucose levels. It also offers customizable alerts to notify users of potential high and low events.

FDA Approval Date: March 8, 2018
Glucose Reading Frequency: every 5 min
Sensor Placement: abdomen (2 and older), buttocks (2–13), or back of the upper arm (14 and older)
Sensor Size: 1.41 × 1.13 × 0.38 in.
Approved Ages: 14 and older for Guardian 3; 7 and older for Guardian 4
Cost: retails around $300 per month
Sensor Duration: 7 days
Waterproof (up to 8 ft): 30 min
Data Sharing: up to 5 people via the Carelink app
Transmitter Range: 20 ft
Calibration: necessary up to 4 times a day
Warm-up Time: 2 h
Overall MARD: 8.7%
Device Compatibility: specified Android and iOS devices, Medtronic receiver, CareLink software, InPen

Senseonics Eversense E3

The Eversense E3 CGM system, developed by Senseonics, consists of a small sensor implanted under the skin by a healthcare professional. The sensor continuously measures glucose levels in the ISF, providing real-time data to the user.

One of the distinguishing features of the Eversense E3 CGM is its long-term wearability, as the sensor can remain implanted for up to six months before needing replacement. The system also includes a wearable transmitter that communicates wirelessly with the sensor to relay glucose data to a compatible mobile app on the user's smartphone. Unlike other systems, this transmitter can be removed for short periods without wasting the sensor.

The Eversense E3 CGM also offers customizable alerts for high- and low-glucose levels, trend information to help users understand their glucose patterns, and the ability to share data with healthcare providers for remote monitoring and management.

FDA Approval Date: March 29, 2023
Glucose Reading Frequency: every 5 min
Sensor Placement: back of the upper arm
Sensor Size: 0.1 × 0.7 in.
Approved Ages: 18 and older
Cost: retails for $2,900–3,500 per year
Sensor Duration: up to 6 months
Waterproof (up to 3 ft): 30 min
Data Sharing: up to 5 people via the Eversense NOW app
Transmitter Range: 25 ft
Calibration: utilizes a calibration algorithm to track sensor glucose sensitivity and notifies users when calibration is necessary; users cannot manually adjust the calibration frequency
Warm-up Time: 24 h
Overall MARD: 8.5%
Device Compatibility: Apple iOS (12.X–17.X), Android (8.0–14.X), and Apple Watch (5.X.X–10.X.X)

Professional CGM Devices

Professional CGM devices are medical tools healthcare professionals use to monitor patients' glucose levels over an extended period. Unlike personal CGM devices worn and operated by individuals, professional CGM devices are typically placed and managed by medical professionals in clinical settings.

These devices are often used for short-term monitoring to gather comprehensive glucose data for diagnostic purposes, treatment optimization, and tracking glucose patterns.

Professional FDA-approved CGM devices include Abbott FreeStyle Libre Pro and Dexcom G6 Pro.

Abbott FreeStyle Libre Pro

The FreeStyle Libre Pro is a CGM sensor reader that stays in the clinic, where healthcare professionals can use it to view glucose data. One reader can scan multiple patients, minimizing waiting time and scheduling issues.

FDA Approval Date: September 28, 2016
Glucose Reading Frequency: every 15 min
Sensor Placement: back of the upper arm
Sensor Size: 1.38 × 0.2 in.
Approved Ages: 18 and older
Cost: system kit containing one reader and four 14-day sensors retails for $299
Sensor Duration: 14 days
Transmitter Range: 20 ft
Calibration: not required
Waterproof (up to 3 ft): 30 min; not recommended for use above 10,000 ft
Warm-up Time: 1 h
Overall MARD: 14.8%
Device Compatibility: certain Apple iOS and Android devices

Dexcom G6 Pro

The Dexcom G6 Pro is an upgraded diabetes management tool used by medical practices, offering real-time patient data access and retrospective data review for healthcare providers.

FDA Approval Date: October 7, 2019
Glucose Reading Frequency: every 5 min
Sensor Placement: abdomen (2 years and older) or the upper buttocks (2–17 years)
Sensor Size: 1.2 × 1.8 in.
Approved Ages: 2 and older
Cost: starter kit retails for $299 for four Dexcom G6 Pro CGM System units, one Dexcom G6 Pro reader package
Sensor Duration: 10 days
Transmitter Range: 20 ft
Calibration: not required
Waterproof (up to 8 ft): 24 h
Warm-up Time: 2 hours
Overall MARD: 11.0%
Device Compatibility: multiple Apple iOS and Android devices

CGM devices have significantly improved diabetes management, offering individuals continuous and accurate real-time tracking of blood glucose levels. With various available options, users can choose the device that best suits their needs, ensuring effective condition management. As technology advances, these devices hold promise in enhancing the quality of life for those with diabetes.

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