You’ll get questions about the new OTC continuous glucose monitoring (CGM) devices...especially as guidelines expand CGM recommendations.
CGM improves A1c and limits hypoglycemia...but has previously only been recommended for kids and adults with diabetes on any type of insulin.
Now guidelines also recommend considering CGM in adults with type 2 diabetes not on insulin...and in pregnant patients with diabetes.
But many payers still require use of at least 1 insulin injection per day...or history of a severe hypoglycemic episode...for CGM coverage.
This may lead other patients with diabetes to OTC options...Stelo, Lingo, and Libre Rio. Plus you may see people without diabetes using CGM.
How do OTC CGMs compare to Rx options? Be aware of differences.
For example, Stelo only reads a glucose range of 70-250 mg/dL and Lingo reads 55-200 mg/dL...while an Rx CGM device like the G7 reads from 40-400 mg/dL. And Stelo and Lingo do not alarm for high or low glucose.
Also be aware that Stelo and Lingo are approved for people 18 and older who do not take insulin. And they are worn on the upper arm...while some Rx CGMs may also be worn on the abdomen and upper buttocks.
Cost is comparable between Stelo and Lingo at about $90 for 2 sensors (1 month supply)...while the Rx CGM sensors G7 and Libre Plus can cost about $380 and $150/month. FSA/HSA may also cover these.
Keep in mind, Abbott’s Libre Rio is approved but not yet available.
What is the role of OTC CGMs? Think of these as designed for people not particularly concerned with low blood glucose because they are not taking meds with a risk of hypoglycemia (sulfonylureas, insulin, etc).
Point out that OTC CGMs are meant to provide insights into the effect of diet and exercise on glucose control...but only Stelo and Libre Rio are approved for daily glucose management in type 2 diabetes.
If patients with diabetes are struggling to afford a CGM, suggest using an Rx CGM a few times per year for a couple of weeks...this can still provide useful information without the huge price tag.
Don’t suggest an OTC CGM for patients with type 1 or type 2 diabetes on insulin or other glucose-lowering meds with a risk of hypoglycemia.
And warn patients that certain smartphone settings, features, and updates may prevent important glucose alerts.
Get our Continuous Glucose Monitoring FAQ for more comparisons.
- American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 Suppl 1):S6-S13.
- American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Care in Diabetes-2025. Diabetes Care. 2025 Jan 1;48(Supplement_1):S146-S166.
- American Diabetes Association Professional Practice Committee. 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes-2025. Diabetes Care. 2025 Jan 1;48(Supplement_1):S306-S320.
- Medication pricing by Elsevier, accessed April 2025.
Prescriber Insights. May 2025, No. 410509