Continuous Glucose Monitoring in Type 2 Diabetes: Can You Crack the Case?

Authors: Anne Peters, MD  Faculty and Disclosures
CME / ABIM MOC / CE Released: 09/29/2023 Valid Credit Through: 09/29/2024

Target Audience and Goal Statement

This activity is intended for primary care physicians, diabetologists/endocrinologists, nurses, nurse practitioners, pharmacists, and other healthcare professionals involved in the care of patients with T2D. 

The goal of this activity is for learners to be better able to use continuous glucose monitoring (CGM) in patients with T2D who are on insulin and/or non-insulin therapy.

Upon completion of this activity, participants will:

  • Have greater competence related to
    • Applying guideline recommendations for CGM use in patients with T2D
    • Overcoming socioeconomic and health equity barriers for using CGM in patients with T2D
    • Utilizing CGM data in practice to manage patients with T2D


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Photo of Anne Peters
Anne Peters, MD

USC Clinical Diabetes Programs
Professor of Clinical Medicine
Clinical Scholar
Keck School of Medicine of USC
Los Angeles, California 

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Anne G. Le, PharmD

Senior Medical Education Director, Medscape, LLC

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Jason Luis Quiñones, PhD

Associate Medical Writer, Medscape, LLC

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Compliance Reviewer/Nurse Planner

Stephanie Corder, ND, RN, CHCP

Associate Director, Accreditation and Compliance, Medscape, LLC

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Peer Reviewer

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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


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Jose, a Hispanic male, 58 years of age has been a construction worker living with type 2 diabetes (T2D) for the past 15 years. He presents to his endocrinologist for a follow-up visit to discuss his ongoing care and diabetes management. He reports that he finds it difficult to manage and monitor his glucose levels, often experiencing 2 to 3 episodes of hypoglycemia per week. Jose reports that during these periods of low blood sugar, he finds himself sweating, trembling, and may feel hungry. He has never had an episode of Level 3 (severe) hypoglycemia but is employed as a construction worker and fears "going low" at work. At his job, he often does not have the time to test his glucose levels and does not always have a break for lunch. On workdays, he arises at 5 AM, has coffee, pan dulce (a Mexican sweet bread), and occasionally a tortilla with beans and rice, and then drives 1.5 hours to his job site, where he starts work at 7 AM.

Jose's endocrinologist reviews his medical history, current treatments, and lab results with him to determine how to move forward in managing his T2D and problematic hypoglycemia (Table 1).

Table 1. Jose's Medical History

Patient information
  • 58 years old 
  • Height: 5'8" 
  • Weight: 175 lb 
  • BMI: 26.6 (overweight) 
Personal and family medical history
  • History of T2D on maternal side
  • Diabetic retinopathy
  • Nonsmoker
  • Consumes 1 to 2 alcoholic beverages per day
  • Experiences 2 to 3 hypoglycemic episodes per week
  • Married and lives with his wife
  • Has 3 grown children
Prior/current treatments
  • Basal insulin
  • Metformin (maximal tolerated dose)
  • DPP-4 inhibitor
  • Rapid-acting insulin injection before dinner
  • Statin
  • ARB
Physical exam
  • No abnormalities noted
Laboratory evaluations and symptoms
  • HbA1c: 8.3%
  • FPG: 115 mg/dL
  • Patient reports 2 to 3 episodes of hypoglycemia per week based on either blood glucose readings or symptoms
    • Resulting in level 2 hypoglycemic (moderate) events: < 54 mg/dL (3 mmol/L)
      • Usually noted by symptoms, as the patient typically does not have his blood glucose meter with him)
    • Accompanied by symptoms of sweating, trembling, and feeling hungry
  • Creatinine ratio: 45
  • eGFR: 67 mL/min/1.73 m2

ARB, angiotensin receptor blocker; BMI, body mass index; DPP-4, dipeptidyl peptidase-4; eGFR, estimated glomerular filtration rate; FPG, fasting plasma glucose; HbA1c, glycated hemoglobin.