More than 5.3 million people have diabetes in Spain, and it is estimated that almost a million more have it without knowing. The community pharmacy, with its enormous capacity for access to the population and its proximity to the patient, is positioned as a key player in the monitoring of the diabetic patient thanks to continuous glucose monitoring (CGM). What a few years ago was a technology reserved for endocrinologists and type 1 patients in hospitals, today is available on the shelves of any pharmacy. But dispensing is not the same as offering a value-added service. This article analyses how CGM is being integrated into the Spanish community pharmacy, what training the pharmacist needs and how the situation in Spain compares with Europe.
What is continuous glucose monitoring (CGM)?
Continuous glucose monitoring (CGM) systems are small sensors that are placed subcutaneously —usually on the back of the arm or on the abdomen— and measure glucose in the interstitial fluid in a practically continuous manner, without the need for repeated capillary finger-pricks.
It is important to distinguish between two types of systems that are often confused:
FGM (Flash Glucose Monitoring) vs. CGM (Continuous Glucose Monitoring): FGM, such as the FreeStyle Libre by Abbott, measures continuously but only displays the data when the patient actively scans the sensor. Real CGM (Dexcom, Medtronic Guardian) transmits data automatically every few minutes and can issue real-time alarms in the event of hypoglycaemia or hyperglycaemia. For pharmaceutical advice, this difference is critical.
Both systems generate the so-called Ambulatory Glucose Profile (AGP), a standardised report that shows the patient's glycaemic variability over the last 14 days in a visual and understandable way.
What is the AGP and what is it used for in the pharmacy?
The AGP (Ambulatory Glucose Profile) is the standard report generated by all CGM systems. It shows the target glucose range (70-180 mg/dL), time in range (TIR), time in hypoglycaemia and hyperglycaemia, and glycaemic variability. The pharmacist can use the AGP to detect problematic patterns (nocturnal hypoglycaemia, repeated postprandial spikes) and refer to the doctor when necessary, or reinforce the patient's therapeutic education.
Comparison of CGM systems available in Spain
The three systems with the greatest presence in Spanish pharmacies in 2026:
The pharmacist as a professional in glycaemic monitoring
Dispensing a CGM sensor is only the first step. What differentiates a pharmacy that offers a value-added service from one that simply sells the product is the pharmacist's ability to:
- Select the appropriate system for the patient's profile (type of diabetes, digital skills, integration with insulin pump)
- Teach how to apply the sensor correctly and avoid common errors (area of lower vascularisation, tight clothing over the sensor)
- Interpret the AGP with the patient and detect patterns that require medical referral
- Advise on hypoglycaemia: when they are frequent, what factors precipitate them, how to act
- Review medication: compatibility of antidiabetic treatment with observed patterns, potential interactions
- Reinforce adherence and therapeutic education (nutrition, exercise, injection technique)
Key fact: time in range (TIR >70% of the time at 70-180 mg/dL) is the glycaemic control indicator that current evidence associates with a lower risk of complications. Improving it by just 5% can have a significant clinical impact. The pharmacist can actively contribute to this goal.
CGM service models in the Spanish community pharmacy
In Spain, different models for integrating CGM into community pharmacy are being developed, ranging from simple dispensing to structured monitoring services:
Model 1 — Active dispensing
The pharmacist dispenses the sensor, explains how it works and how to apply it, and recommends follow-up by the medical team. This is the most widespread model currently. It adds value compared to simple sales, but does not involve continuous monitoring.
Model 2 — CGM initiation service
The pharmacy offers a structured session for starting the CGM service: application of the first sensor, configuration of the app or reader, explanation of the AGP and first reading of results. This is documented in the patient's pharmacotherapeutic record. Some Spanish pharmaceutical colleges (professional bodies) have established collaborative protocols with health centres for this model.
Model 3 — Integrated pharmacotherapeutic monitoring
The most advanced model includes periodic visits (monthly or bimonthly), joint review of the AGP, adjustment of therapeutic advice and bidirectional communication with the referring doctor via a pharmacist's report. This model requires dedicated time, adequate physical space for the consultation and specific training in diabetology.
Important: the pharmacist does not prescribe or adjust insulin doses. When the AGP analysis reveals frequent hypoglycaemia, patterns of persistent hyperglycaemia or high variability, referral to a doctor is mandatory and urgent if the situation requires it. Please check your own national regulator for any regulatory guidance.
Training required for the pharmacist
To offer a quality CGM service, the pharmacist needs training that goes beyond product knowledge. The key areas are:
Differences between type 1, type 2 and LADA. Mechanism of action of insulins, GLP-1 analogues, SGLT-2 inhibitors and DPP-4 inhibitors. Interactions with the glycaemic patterns observed in the CGM.
Application and removal of sensors, operation of transmitters, configuration of apps and readers, calibration when necessary, troubleshooting common errors (erroneous readings in the first few hours, sensor detached, paracetamol interference).
Reading the ambulatory glucose profile: time in range (TIR), time below range (TBR), estimated average glucose (eA1c), glycaemic variability (CV%). Identification of patterns: nocturnal hypoglycaemia, postprandial peaks, fasting hyperglycaemia.
Motivational interviewing, communication techniques for patients with low adherence, adaptation of advice to the level of digital health literacy. How to explain the AGP in an understandable way without creating anxiety about the data.
Clear criteria for urgent referral (severe hypoglycaemia, severe hyperglycaemia, ketoacidosis). Communication with the GP or endocrinologist via a structured report. Coordination with liaison nursing.
SEFAC (the Spanish Society of Clinical, Family and Community Pharmacy) and the General Council of Pharmaceutical Colleges (the national Spanish body) offer specific continuing education programmes in diabetes and applied technologies. SEFAC conferences usually include practical CGM workshops with real patients.
Spain in the European context
Spanish community pharmacy is advancing, but still has a way to go compared to the most developed models in Europe:
| Country | CGM dispensing | Initiation service | AGP review | Medical-pharmacy collaborative protocol |
|---|---|---|---|---|
| United Kingdom | Yes (NHS) | |||
| Netherlands | Yes | |||
| France | In development | Partial | ||
| Spain | Pioneer pharmacies | Nascent | No national framework | |
| Portugal | Partial | |||
| Germany | Regional |
The main difference between Spain and the most advanced models (United Kingdom, Netherlands) is the existence of a regulatory and funding framework that recognises the CGM pharmacy service within the healthcare system. In Spain, pharmacies offering this service do so largely on their own initiative and without specific remuneration from the system, except in some regional pilot projects.
The path towards the pharmacy as a health hub
The integration of CGM is a paradigmatic example of the evolution that community pharmacy is experiencing: from a dispensary to a health hub. This transition has professional and employment implications for the pharmacy team:
- Higher qualification required: pharmacy technicians and assistants also need basic training in CGM to be able to handle the most frequent queries about the meter and appropriately refer to the pharmacist.
- Space reorganization: consultation services require a distinct area with privacy and minimum equipment (reader or tablet for AGP, sensor application material).
- Documentation and traceability: the pharmacotherapeutic history and intervention log are essential for coordination with the medical team and for service evaluation.
- Impact on the employment agreement: the assumption of new clinical competencies should be reflected in professional and salary recognition, one of the arguments supporting the demands in the negotiations of the 26th National Agreement.
Future outlook: the Ministry of Health's Chronic Care Plan and regional diabetes plans explicitly include community pharmacy as a node for chronic patient monitoring. CGM is the technology that can make that role tangible, with measurable and communicable health outcomes.
Frequently asked questions
Can a pharmacist apply the continuous glucose sensor?
Yes. The application of the CGM sensor is an activity that can be carried out by the community pharmacist within the framework of pharmacotherapeutic monitoring. The most widespread systems (FreeStyle Libre, Dexcom G7) are simple to apply on the back of the arm. Specific training on the particular system is essential to guarantee correct application and avoid errors.
What is the difference between flash glucose monitoring (FGM) and real continuous CGM?
FGM (Flash Glucose Monitoring), such as FreeStyle Libre, measures continuously but only displays the data when the patient scans the sensor. Real CGM (Dexcom, Medtronic Guardian) transmits automatically every few minutes and can emit real-time alarms for hypoglycaemia or hyperglycaemia without the patient needing to do anything. This distinction is fundamental for recommending the appropriate system according to the patient's profile.
Are CGM systems publicly funded in Spain?
Yes, partially. The FreeStyle Libre is funded by the SNS (Spanish National Health System; please check your own national regulator for local funding) for patients with type 1 diabetes and type 2 diabetes on intensive insulin therapy. Dexcom is funded in some autonomous communities with specific criteria. Patients with type 2 diabetes not on intensive insulin therapy usually purchase them without funding. The community pharmacy is the main point of dispensing and monitoring.
What training does the pharmacist need for the CGM service?
For a structured CGM service, the pharmacist needs: training in clinical diabetology and pharmacotherapy, management of available CGM systems (application, reading the AGP, alarms), skills in therapeutic education and motivational interviewing, and referral protocols to the doctor. SEFAC (Spanish Society of Clinical, Family and Community Pharmacy) and the Consejo General de Colegios Farmacéuticos (General Council of Pharmaceutical Colleges of Spain) offer specific continuing education in this area.
How does Spain differ from other European countries regarding CGM in pharmacy?
The main difference is the absence in Spain of a regulatory and funding framework that recognises the pharmacy CGM service within the healthcare system. In the UK and the Netherlands, the NHS/healthcare system remunerates the CGM monitoring service in community pharmacy with structured doctor-pharmacy collaborative protocols. In Spain, pharmacies mostly do this on their own initiative without specific remuneration from the system.
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Calculate my pharmacy payslip- Soriguer F, et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@bet.es Study. Diabetologia. 2012;55(1):88-93.
- SEFAC — Spanish Society of Clinical, Family and Community Pharmacy. Position papers on pharmaceutical services in diabetes. sefac.org
- Battelino T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603.
- International Diabetes Federation. IDF Diabetes Atlas, 10th edition. Brussels, Belgium: IDF, 2021.
- Abbott Diabetes Care. FreeStyle Libre 3 — Technical data sheet and instructions for use.
- Dexcom. Dexcom G7 Continuous Glucose Monitoring System — Instructions for use.