Recommendations by a Specialist Panel on the Use of Continuous Glucose Monitoring with FreeStyle Libre System in Costa Rica

Abstract

Background: Continuous glucose monitoring has transformed diabetes care globally, yet no national guidelines exist in Costa Rica to guide its clinical use. This document aims to develop evidence-informed, context-specific recommendations for implementing continuous glucose monitoring in the Costa Rican healthcare system. Methods: We conducted a structured literature review focused on FreeStyle Libre 14-day and FreeStyle Libre 2 systems, including publications from 2015 through November 16, 2024. Ten clinical scenarios reflecting local practice needs were developed a priori. On February 1, 2025, six endocrinologists from Costa Rica’s public and private sectors convened in San José and employed a modified Delphi process with anonymous voting to approve recommendations at a prespecified threshold of≥80% agreement. Results: The panel issued 20 recommendations. Continuous glucose monitoring has been endorsed as the standard of care in type 1 diabetes and during pregnancy with type 1 diabetes. Selective use was supported in type 2 diabetes, especially for insulin-treated patients, those with hypoglycemia risk, and as a short-term educational tool, considering the particularities of the Costa Rican health care system. Use during hospitalization was recommended for stable patients able to self-manage. Routine use of continuous glucose monitoring in critically ill patients, individuals without caregiver support, or those receiving dialysis was discouraged. All uses should be paired with education and clinical oversight. Conclusions: These FreeStyle Libre 14-day and FreeStyle Libre 2 suggestions provide practical guidance for local implementation and identify priorities for future research, education, and health policy in Costa Rica.