Why CGM Access and Diabetes Amputations Are Part of the Same Systemic Problem: Alyson K. Myers, MD

The gap between who receives continuous glucose monitors (CGMs) and who ultimately faces diabetes-related amputations is not coincidental—it reflects the same structural inequities, according to Alyson K. Myers, MD, professor at Albert Einstein College of Medicine and associate chair of faculty mentoring and community engagement at Montefiore Einstein, department of medicine, and chair of the “Adapting Diabetes Care for All” session featuring the “Felicia Hill-Briggs Trailblazer in Health Equity” award lecture at the 86th Scientific Sessions of the American Diabetes Association (ADA).

"They very often do go hand in hand," Myers said in an interview with The American Journal of Managed Care^®. "A lot of what we need to do in terms of diabetes prevention for complications starts with good glycemic control, and sometimes the best way to get glycemic control is to have access to these continuous glucose monitors."

Myers applies a socioecological framework to understand these disparities—peeling away layers of the problem like an onion, from the patient outward. At the patient level, social determinants of health loom large: food deserts, transportation barriers, limited Wi-Fi access for telehealth, and language barriers all affect a patient’s ability to consistently engage with care. Numeracy is another underappreciated obstacle. "Diabetes is a very mathematical condition," she noted, adding that providers must not assume patients intuitively know how to interpret and act on CGM readings.

At the provider level, Myers highlighted implicit bias as a significant barrier alongside cultural humility. Understanding how to guide patients through practices like Ramadan fasting requires genuine engagement, not assumption. Physician wellness also factors in. "Are we at a place where we are dealing with compassion fatigue, so we can't give our best?" she asked.

Finally, policy and institutions must reinforce these efforts through bias training and structural support. Until each layer is addressed, Myers argued, technology access and complication prevention will remain inequitably distributed—connected failures demanding a connected solution.