Continuous Glucose Monitoring Beyond Intensive Insulin Therapy in Type 2 Diabetes: Evidence, Over-the-Counter Devices, Equity, and Clinical Implementation.

Continuous glucose monitoring (CGM) measures interstitial glucose over time and is increasingly used beyond intensive insulin therapy in type 2 diabetes. In routine care, CGM is useful when pattern information can improve management, not simply because more glucose data are available. This structured narrative review summarizes evidence, device categories, over-the-counter (OTC) systems, equity considerations, and practical implementation for adults with type 2 diabetes who are not receiving intensive insulin therapy, with particular focus on non-insulin-treated adults and those treated with basal insulin without prandial insulin. In non-insulin-treated adults, CGM may help identify fasting or postprandial hyperglycemia, support lifestyle and adherence discussions, and clarify discordance between hemoglobin A1c (HbA1c) and daily glucose patterns, although evidence remains stronger for glycemic metrics than for long-term outcomes. In adults treated with basal insulin without prandial insulin, randomized trial evidence supports CGM for glycemic assessment and safer treatment review. Systems cleared by the US Food and Drug Administration (FDA) for OTC CGM use and consumer-facing glucose biosensors may increase access to glucose feedback, but intended use, diabetes-specific clinical evidence, and broader wellness use should be distinguished. This review presents a practical implementation framework that begins with patient selection, followed by education, structured interpretation of CGM data, and integration of findings into lifestyle counselling, medication review, and shared clinical decision-making while accounting for coverage, digital access, language-sensitive support, and safety risks. CGM should function as structured decision support, not passive surveillance or consumer data collection.