It takes a village to raise a child, the proverb says. Can the same be said for creating and maintaining successful regimens for patients living with diabetes?
New research published in Clinical Diabetes, the journal of the American Diabetes Association, suggests the answer is yes.
The article — Impact of Continuous Glucose Monitoring [CGM] Sourcing on Real-World Adherence and Health Care Costs: A Comparative Analysis by Insurance Type — examined the outcomes for patients with diabetes receiving CGM supplies from durable medical equipment (DME) providers compared to patients receiving those supplies from pharmacies.
Researchers studied the data of patients enrolled in traditional Medicare, Medicare Advantage, and commercial insurance payers. What the study’s authors uncovered supports the premise that the CGM provision process has a significant impact on eventual patient outcomes.
What the study found
The study’s authors — Jason C. Allaire, Consuela Dennis, Eugene E. Wright Jr., Steven V. Edelman, and Arti Masturzo — found that patients who received their CGM supplies from DME providers were more adherent to their physician-prescribed treatments than patients who received CGM supplies from pharmacies.
Better adherence when working with DME providers was consistent across insurance payers. By the 12-month mark, Medicare and Medicare Advantage patients had a 78% adherence rate with DME providers vs. a 64% adherence rate with pharmacies. At that same 12-month mark, patients with commercial insurance had a 60% adherence rate with DME providers and a 48% adherence rate with pharmacies.
Furthermore, health-care costs at the 12-month mark for Medicare and Medicare Advantage patients receiving CGM supplies from DME providers were 35% lower than the health-care costs for Medicare/Medicare Advantage patients receiving their supplies from pharmacies. Researchers reported that commercially insured patients who received supplies from DME providers had “significantly fewer emergency room and [hospital] inpatient days than those utilizing the pharmacy channel — eight days vs. 11 days,” according to a March 25 news announcement.
“Higher adherence rates with continuous glucose monitors are directly linked to improved glycemic control, reduced complications, and lower health-care costs,” said Steven Edelman, M.D, one of the study’s authors. “This latest research emphasizes the need for industry-wide support of evidence-based decisions that optimize patient access to diabetes technology and improve clinical outcomes.”
In addition to supporting the efficacy of diabetes technology, the study’s results also demonstrated that who provides the diabetes supplies absolutely matters.
“This research presents an opportunity to align health-plan policies with provider preferences based on measurable outcomes,” said Arti Masturzo, M.D., MBA, one of the study’s authors and the chief medical officer at CCS, a provider of clinical solutions and home-delivered medical supplies for those living with chronic conditions. “The data shows patients utilizing DME providers experience higher adherence rates, reduced health-care costs, and fewer emergency interventions compared to pharmacy channels. By focusing on these evidence-based results, we can work toward building a health-care system where patients receive better diabetes management support while reducing costs for the entire system.”
The challenges of using CGMs
In a video interview with HME Business, Masturzo pointed out that the March 2025 study is not the first to deliver these kinds of findings. A March 2024 study — Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients with Diabetes: Retrospective Claims Analysis, published by JMIR Diabetes — also compared adherence rates for patients receiving CGM supplies from DME providers vs. pharmacies. That research showed, as one example, six-month adherence of 65% for patients working with DME providers, and 52% adherence for patients who got their supplies from pharmacies.
“That’s how [you know] the data is solid: When you repeat the study and see the same trends,” Masturzo, an author for both studies, explained. She added that the first study found that 22% of patients who stopped their diabetes regimens, but had been working with DME providers, resumed treatment, compared to just 10% of pharmacy patients resuming treatment.
“So, twice as likely to resume therapy after stopping,” she noted of patients working with providers.
The next logical question is why patients in the study who received diabetes supplies from DME providers had better outcomes than patients who also received diabetes supplies, but from pharmacies.
Masturzo tried a CGM herself because as a prescribing physician, “It’s important to know who’s getting these,” she said. In fact, when she first tried to apply the CGM sensor to her arm, “I bent the needle, and I kind of broke it. So I wasn’t able to use it.”
During the interview with HME Business, Masturzo held up a CGM sample. “This is a sensor,” she said. “It goes on your skin, and then your phone basically acts as a receiver and you can read it. It’ll tell you in real time what your glucose readings are. And the prescription version gives you an alert when your blood sugar’s too high or too low.”
She then held up a sizable CGM brochure printed in small type: “These are the instructions.” Masturzo pointed out that some patients trying to read the brochure would surely have diabetic retinopathy, which damages the retinas and can lead to vision loss. “If you think about the complexity of [CGMs] — it’s not like an EpiPen. With Ozempic and some of those drugs [for treatment of diabetes], patients can inject the drugs. But [CGMs] can be complicated.”
That’s one reason, Masturzo believes, that patients working with DME providers have had better outcomes according to the pair of studies.
How DME workflows can benefit CGM patients
“Medicare has specific regulations for devices like this in general durable medical equipment [policies],” Masturzo said. “To bill Medicare and ship these devices, you have to ensure that the equipment is being used, and that the patient is capable and trained to use the device to bill a claim. That is not the case on the pharmacy side.”
As a prescribing physician, Masturzo has personally seen the difference between working with DME providers and pharmacies. “I know what happens when I write an order through my DME [provider],” she said. “They come back in a week and say, ‘Hey, Mrs. Smith is doing this,’ or ‘She didn’t do this,’ or ‘She didn’t order this.’ I never hear from my pharmacist, ‘Hey, Mrs. Smith didn’t do this.’”
Providers are also more interactive with those prescribing physicians. “Unlike pharmacies and pharmacists, the DME rep is constantly in the physician’s office and talking to the clinicians, talking to the coordinators, care managers, and more,” Masturzo said. “They’re also directly talking to the people who make these supplies, the original manufacturers. You get this cross communication in the community, in the [physicians’] offices, and so you get more support for these patients.”
Medicare’s operational rules for providers also benefit CGM patients, Masturzo added: “DMEs have really robust reorder protocols so that people stay on therapy.”
Masturzo said a lot of the claims analysis for the CGM studies understandably came from national providers, who “create divisions within the DME company itself: ‘Here’s my oxygen tank team, here’s my wheelchair team, here’s my CPAP and BiPAP team, and this is my diabetes team — all they do is diabetes.’
“What happens is you start hiring experts in diabetes, people who know diabetes. You get focused, and that just means a higher level of support and expertise for people who are supplying these [CGM supplies].”
Does this mean that Masturzo would prefer that pharmacies not be allowed to dispense CGM supplies, even in remote areas where pharmacies could be the most accessible type of health-care business?
“There are communities and environments where pharmacists and pharmacies play a pivotal role,” Masturzo said. “And so the purpose of this study is not ‘You should close down all pharmacy channels.’ The whole point is that we should let physicians decide which channel serves patient needs best, period.”
That is not what the industry is currently experiencing, Masturzo added.
“What we’re seeing right now is, increasingly, a push to pharmacy for [CGM distribution],” she said. “And you can see from the claims data: It’s not only that people [who receive CGM supplies from pharmacies] are not as adherent. People use CGMs for a couple of months, and then they stop. If you think about it from a taxpayer [perspective], you got no benefit from it.”
How DME businesses provide more robust support
Masturzo’s position as CCS Medical’s chief medical officer is evidence of how differently DME providers view the CGM segment and its patients.
“People have just forgotten that our responsibility, as the smartest DME, is to maximize the impact that we have in every patient interaction. What we’ve developed is above and beyond coaching and education. Beyond monitoring your blood pressure, and giving you a scale, and developing clinical programs. Going above and beyond is really what patients with chronic conditions need and deserve.
“What gets me excited is that we just launched a predictive analytics platform that can predict with almost 90% accuracy if somebody’s going to stop using their CGM. And then we innovate technology to create personalized interventions with those patients to improve adherence and overall health and well-being.”
Masturzo circled back to her first interaction with a CGM sensor. “I twisted it too much,” she said. “I broke it. Who am I going to call if I got this shipped to me? Most of [pharmacy CGM distribution] is mail order, so it’s not even going through a brick-and-mortar. It’s not like I can show up [at the brick-and-mortar] with my CGM and say, ‘Look what I did.’ Instead, I get a telephone tree of people.”
Many patients using CGMs do need the specialized and personalized support that providers offer, Masturzo said.
“When you think about the reasons why people have trouble with these, sometimes, especially in the elderly, the skin is really thin and fragile,” she explained. “How do you troubleshoot that? What about people who are super active and sweating all the time?
“That’s why I feel there’s a reason [CGM provision] was started in DME from the very beginning. I think we’ve forgotten why the regulations were developed the way they were. We have this mentality of speed and more access [via pharmacies]. And then we forget fundamentally that the CGM is only as good as the people who know how to use it.”
Undoubtedly, tech-savvy patients who are internally motivated to adhere to their CGM regimens could receive their supplies from pharmacies and do fine. But it’s a different story for many other patients who need more support to use CGMs properly and remain adherent.
Masturzo agreed that if “you’ve got a doctor that has a lot of bandwidth and resources,” patients receiving supplies from pharmacies could do well. But she added, “There’s a wait time of three to eight weeks for an endocrinologist. PCPs [primary care physicians] have 15 to 20 minutes [per patient]; they simply don’t have the resources.”
Therefore, she said, “I wouldn’t want my mom getting this through a mail-order pharmacy. I would want somebody to call her and say, ‘Hey, how are you doing?’ If you look at the data and the study, and you look at the number of people that drop off, I think there are people who decide ‘I don’t even want to put this on, I’m too scared.’ And so the CGM just sits there.”
The good news is that research has shown a better, more cost-effective way forward. DME providers can boost adherence rates, which reduces overall health-care costs as a result.
The fact is that many CGM patients need the proactive communication, education, training and personalized village of support that DME providers can offer.
“I believe fundamentally that there are spots in health care where you can still be profitable doing the right thing and everybody wins,” Masturzo said. “And this is one of those situations. If you do this right, and you’re following the [CGM] guidelines, and you’re doing the necessary education and making sure people know how to use CGMs — people are benefiting. You’re building a business on holistic, personalized and preventive patient care, not just shipping medical devices to get them from point A to point B as fast as possible.”
