Self-monitoring of blood glucose is a key pillar of diabetes therapy. This is especially essential for people with diabetes who are undergoing insulin therapy. For the purpose of therapy monitoring, however, it is also relevant for people with type 2 diabetes whose treatment involves non-insulinotropic oral antidiabetic agents or incretin mimetics.
This can be done either through point-in-time blood glucose measurements (SMBG) or, very effectively in real time, using continuous glucose monitoring (CGM) (see chapter “Self-monitoring”).
Given the partially controversial discussion regarding the use of CGM in type 2 diabetes without insulin therapy, several clinical studies are presented below.
In general, the use of real-time CGM systems (also referred to as rtCGM) offers a number of advantages, also in comparison to SMBG [1]. These include improvements in glycemic control:
Additional improvements can also be achieved:
The advantages described are primarily relevant for patients undergoing insulin therapy. This includes people with type 1 diabetes as well as people with intensively treated type 2 diabetes.
Whether a CGM is reimbursed and prescribable by the national health system always needs to be checked again with up-to-date information, since this changes continuously. The following is a rough overview of September 2025.
Countries that provide reimbursement for insulin-treated type 2 diabetics
Country | Status / Conditions |
Germany | CGM (realtime) is reimbursed for “insulin-treated” diabetes mellitus (type 1 and type 2) under certain requirements. Med Tech Reimbursement Consulting +3, Dexcom Investor Relations +3, Diabetes Atlas +3 |
France | National reimbursement for CGM for type 2 diabetics using insulin. For example, FreeStyle Libre 2 has been expanded to also cover people on basal insulin. Abbott MediaRoom +2 |
United Kingdom (NHS) | Dexcom ONE rt-CGM is prescribable for people with type 2 diabetes who use insulin. Dexcom Investor Relations +1 |
USA
In the USA, reimbursement depends heavily on the insurer (Medicare, Medicaid, private insurance). In recent years, there have been important expansions, particularly with Medicare. Here are the key points:
Aspect | Regulation / Status |
Medicare (federal, for people over 65 or with certain disabilities) | Since April 16, 2023, “expanded coverage” applies: CGM is now covered for people with diabetes who use any form of insulin (not only intensive regimens), as well as for people without insulin therapy if they have a history of “problematic hypoglycemia.” (diaTribe) |
Medicare criteria | • A prescribing physician must determine that the patient can use and understands the system. (American Diabetes Association) • The prescription must comply with FDA indications. (AAFP) • Physician follow-up: prior to initiation, and then every 6 months (in person or via approved telemedicine). (American Diabetes Association) |
Private insurers / commercial plans | Many private insurers align with Medicare criteria, but often add requirements (e.g., minimum number of insulin injections, HbA1c thresholds, documented hypoglycemia). Some deny coverage if no insulin or only basal insulin is used. Varies widely by insurer. (anthem.com) |
Summary: insulin-treated type 2 diabetics | Yes – they are generally eligible for CGM under Medicare, provided insulin is used. Since the expansion, the intensity of insulin therapy (basal only vs. basal + bolus) matters less. For private insurers: criteria vary. |
India
In India, reimbursement is much less regulated regarding public or statutory health insurance. The main challenges are cost, access, and the fact that many insurers — especially for outpatient care — do not cover technological devices like CGMs. Details:
Aspect | Regulation / Status |
Availability of CGM | Various systems (e.g., FreeStyle Libre) are available in India. Abbott, for example, launched FreeStyle Libre in India for people with diabetes (type 1 and type 2). (abbott.in) |
Insurance reimbursement | There is no nationwide statutory reimbursement or mandatory coverage for CGM in India, not even specifically for insulin-treated type 2 diabetics. Private insurers usually have strong limitations, and most coverage focuses on hospitalization costs, medications, etc., less on advanced monitoring devices. (Reddit) |
Recommendations and guidelines | Professional bodies like Diabetes India and RSSDI mention CGM as useful for better control and complication prevention, but this does not mean reimbursement by insurers or public health programs. (abbott.in) |
Real-world studies | Studies show CGM (e.g., FreeStyle Libre) can improve outcomes in Indian type 2 diabetics, but this does not automatically mean the devices are reimbursed. (Cureus) |
More recent studies, however, show that people with type 2 diabetes also benefit from CGM when they are on BOT (basal insulin supported oral therapy) or are not treated with insulin at all. For non-insulin-treated people with type 2 diabetes, the main benefit lies in “biofeedback,” i.e., insights into the effects of food and exercise on glucose levels, which can lead to behavioral modification and adaptation. A crucial prerequisite is close collaboration with the diabetes care team.
Advantages of continuous glucose monitoring (CGM) in type 2 diabetes
Thus, the effect of CGM in people with type 2 diabetes depends largely on the type of therapy applied:
While the evidence for CGM under ICT is compelling, its use in other cases remains subject to controversy, partly due to associated costs. However, there are already international recommendations, e.g., from the American Association of Clinical Endocrinology (AACE), which extend the use of CGM under defined circumstances to people with type 2 diabetes without insulin therapy [3].
Real-world data from a total of 3,840 patients illustrate the long-term improvements in glycemic control with CGM use in people with type 2 diabetes without insulin [4]. These data demonstrate how a system or therapy functions under everyday conditions, i.e., they are practice-relevant. The analysis showed that after 6 months of CGM use, the proportion of time in range increased by 15.1% to 56.8%. The proportion of readings in the low glucose range (54–<70 mg/dl) remained nearly unchanged at a low level (baseline 0.1%; 6 months 0.2%). Comparable results were also observed after 12 months of CGM use.
Although non-insulin-treated patients cannot adjust medication in response to immediate glucose readings, “biofeedback” supports lifestyle interventions.
Overall, various studies (randomized, prospective, and retrospective) suggest that all groups of people with type 2 diabetes benefit from CGM use [5,6,7]. This is further confirmed by a meta-analysis of databases such as Embase, MEDLINE, and others (data through May 2023) [8]. Improvements with CGM versus SMBG in people with type 2 diabetes without insulin are comparable to those in people with insulin therapy (see Fig. T2D 1).
Fig. T2D 1: Comparison of CGM vs. SMBG use in people with type 2 diabetes (summary results of all studies). For HbA1c (top), stratification was performed according to the type of glucose-lowering therapy (insulin users, non-insulin users, or mixed populations of insulin users and non-users). For “Time in Range” (bottom), the different therapy regimens were pooled [8 adapted from Jancev M et al.].
What are the benefits of continuous glucose monitoring (CGM) in type 2 diabetes?
A key advantage of CGM use lies in the positive experiences reported by people with type 2 diabetes. These benefits relate both to glycemic management and to behavior. In a survey of CGM users around the age of 60, the following perceptions emerged:
With respect to metabolic control, the surveyed cohort showed an improvement in HbA1c after 3 months of CGM use by 1.9%, from 9.1% to 7.2%.
These findings demonstrate that CGM can also be an effective tool for people with type 2 diabetes who are not treated with insulin, supporting lifestyle interventions. This is particularly important in this patient group, as it enables therapy optimization and improves long-term health prospects. Increased interest in the use of this technology not only promotes behavioral changes but also strengthens overall engagement in diabetes self-management. Furthermore, this represents an important signal to payers, showing that the financial investment in CGM can be worthwhile in the long term.
Nevertheless, it is essential that CGM use in non-insulin-treated patients be supported by close guidance from the diabetes care team. Unlike in people with intensified insulin therapy (ICT), where the benefits of CGM (e.g., predictive alerts for hypoglycemia) are directly tangible, in non-insulin-treated patients the effects may not be as immediately evident and often require explanation. Digital health applications can provide support but cannot replace the diabetes care team.
Literature:
[1] Thomas A, Haak T, Tombek A et.al. How to Use Continuous Glucose Monitoring Efficiently in Diabetes Management: Opinions and Recommendations by German Experts on the Status and Open Questions. J Diabetes Sci Technol. 2024 Aug 11:19322968241267768. doi: 10.1177/19322968241267768. Epub ahead of print.
[2] Federal Ministry of Health: Announcement of a resolution of the Federal Joint Committee on an amendment to the guideline on methods of statutory health care: Continuous interstitial glucose monitoring with real-time monitoring devices (rtCGM) for therapy control in patients with insulin-dependent diabetes mellitus, dated June 16, 2016. Federal Gazette, published by the Federal Ministry of Justice and Consumer Protection, dated September 6, 2016.https://www.g-ba.de/downloads/39-261-2623/2016-06-16_MVV-RL_rtCGM_BAnz.pdf?msclkid=ddce3b8ad03111ec9258e12d62f0496e. Letzter Zugriff: 12.06.2025.
[3] Grunberger G, Sherr J, Allende M, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract. 2021;27(6):505-37. Epub 2021/06/13. doi: 10.1016/j.eprac.2021.04.008. PubMed PMID: 34116789.
[4] Layne JE, Jepson LH, Carite AM, Parkin CG, Bergenstal RM. Long-Term Improvements in Glycemic Control with Dexcom CGM Use in Adults with Noninsulin-Treated Type 2 Diabetes. Diabetes Technol Ther. 2024 Jun 21. doi: 10.1089/dia.2024.0197. Epub ahead of print. PMID: 38904213.
[5] Ehrhardt N, Al Zaghal E. Continuous Glucose Monitoring As a Behavior Modification Tool. Clin Diabetes 2020; 38(2): 126-131. DOI: 10.2337/cd19-0037
[6] Martens T, Beck RW, Bailey R, et.al.; MOBILE Study Group. Effect of Continuous Glucose Monitoring on Glycemic Control in Patients With Type 2 Diabetes Treated With Basal Insulin: A Randomized Clinical Trial. JAMA. 2021;325(22):2262-2272.
[7] Aleppo G, Hirsch IB, Parkin CG, et.al. Coverage for Continuous Glucose Monitoring for Individuals with Type 2 Diabetes Treated with Nonintensive Therapies: An Evidence-Based Approach to Policymaking. Diabetes Technol Ther. 2023;25(10):741-751.
[8] Jancev M, Vissers TACM, Visseren FLJ, van Bon AC, Serné EH, DeVries JH, de Valk HW, van Sloten TT. Continuous glucose monitoring in adults with type 2 diabetes: a systematic review and meta-analysis. Diabetologia 2024;67(5):798-810.