Pharmacy researchers propose more equitable usage of continuous glucose monitoring for diabetes

BUFFALO, N.Y. ­­­­— When diabetes patients track their blood sugar with a 24-hour  wearable device, they manage their glucose more precisely and reduce the risk of hypoglycemia and other problems.

In 1999, the U.S. Food and Drug Administration approved continuous glucose monitoring (CGM), a medical device that uses a tiny monitor inserted under the skin that measures sugar levels in real time. It’s preferable to the traditional fingerstick blood glucose test, which only shows glucose levels at one point in time.

However, underserved populations use CGM much less frequently than their counterparts. This is due to barriers such as low digital and health literacy, financial hardship and limited provider engagement, according to a commentary published by a group of researchers in the Department of Pharmacy Practice in the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

They examined CGM use among underserved populations, particularly immigrants and refugees, and highlighted their findings — in addition to possible solutions — in the March-April 2026 edition of the Journal of the American Pharmacists Association.

Christ Ange (Angel) Cellino, PharmD, clinical assistant professor, and En-Ling (Ann) Chen, PharmD, postdoctoral associate, are the principal authors.

Gina Prescott, PharmD, clinical professor, Christopher Daly, PharmD, clinical associate professor, David Jacobs, PharmD, PhD, associate professor, and Julia Pawelek, doctoral student, also contributed to the commentary.

Unique needs of immigrants and refugees

Cellino and Chen both noticed the same barriers to care while providing pharmacy services to low-income refugees and immigrants at Jericho Road Community Health Center in Buffalo.

“I saw how this unique population has different challenges and needs compared to general populations, language being a main one,” says Chen, who assisted with clinical pharmacy research at the health center.

Cellino, along with Prescott and Daly, provides pharmacy services, engages in research and precepts pharmacy students in an ongoing capacity at Jericho Road.

“Patients prescribed the device were coming to us for assistance often well after the initial fill date,” Cellino says. “We noticed many were falling through the cracks due to delay in the coverage/fill process, limited health and digital literacy.”

Chen, who works with Daly and Jacobs to identify barriers patients face in general pharmacy care, notes that things like transportation issues and food insecurity can sometimes become the main determinants of poor health outcomes.

“I think the same applies to CGM,” she says. “The unique needs and barriers that Jericho Road patients are experiencing could be the major reason for the underutilization of CGM, as it is one of the devices that requires high digital literacy and health literacy to maximize its clinical benefits.”

Pharmacists breaking down barriers to care

In the article, they emphasize that pharmacists are uniquely positioned to break down some of the barriers. For instance, they can help patients navigate insurance and teach them how to integrate CGM into their diabetes management while also identifying barriers that may impede continual CGM use.

And they are filling an important gap. They point to a recent national study of more than 1,300 primary care providers, revealing that while most perceived clear benefits of CGM, only 52% intended to discuss the technology with eligible patients.

“The CGM is different than the traditional glucometer device,” Prescott says. “If patients are used to using a glucometer, we need to talk to them about the intricacies of the CGM. Also, the devices are changing pretty rapidly because the technology keeps improving, and there becomes another wave of education that needs to occur.”

Coming from a different culture can create another barrier. Most CGMs are only available in English and Spanish.

“It doesn’t work with our population at Jericho Road, for instance, just to give someone a device and send them out the door because you can’t convert it into their language,” Prescott says.

Suggestions the researchers have made for improved use included establishing a dedicated day for global review of CGM data, as well as relying on interns, student pharmacists and postdoctoral trainees for additional help in community pharmacies.

They point to one case involving a 52-year-old non-English speaking patient who had been referred to the clinical pharmacy team following an episode of acute hypoglycemia. The pharmacists worked with the patient’s primary care provider to address the needed health and digital literacy challenges. They also worked on ways to correct hypoglycemia in the patient’s own language through a phone interpretation service.

Consistent follow up with the pharmacy team helped keep treatment consistent.

“Hopefully, highlighting cases like this brings more attention to the need to push past barriers,” Cellino says. “It also shows how we, as pharmacists — in the clinical, community and even academic settings — can help close that gap and further advance equitable care in diabetes.”

The huge caveat is there needs to be a better infrastructure in place to support the pharmacist’s time and pay the technicians and pharmacy interns, Prescott notes.

With dedicated effort and more education, she says it’s possible for the suggested solutions to be implemented, especially in independent pharmacies.

At Jericho Road, the UB pharmacists have identified the benefit of  having pharmacy students who are dedicated to showing the patients how to use the CGM device and answer their questions.

“I think student pharmacists would benefit from such an experience early on,” Cellino says. “They can help underserved populations while also developing patient care skills that will undoubtedly make them excellent practitioners.”