JMIR Publications

ABSTRACT

Background:

Federally Qualified Health Centers (FQHCs) provide service to medically underserved areas and communities. The burden of Diabetes is increasing but often these vulnerable communities lag in the management of the disease due to health inequities and technological obstacles.

Objective:

The aim of this pilot study is to assess the implementation and outcome of a Continuous Glucose Monitoring (CGM) Program at an urban FQHC, the Community-University Health Care Center (CUHCC) and to enumerate lessons learned for an overarching digital strategy.

Methods:

The CGM program was implemented with an interdisciplinary approach involving pharmacists, clinicians, and nurses. Patients with established care at CUHCC, over/equal 18 years of age, and with a diagnosis of Diabetes were eligible for the study. Participation was voluntary and verbal consent was obtained. CGM devices were prescribed to insured patients, and Libre Pro devices were provided, using a Fund donation, to patients who were uninsured or had unaffordable co-pays. Eligible patients were scheduled for enrollment visits where CGM devices were applied by pharmacists along with patient education. The baseline HbA1c level was the most recent HBA1c prior to CGM program enrollment, with follow-up HbA1c defined as the 3 and 6 months after baseline/enrollment. The outcome metrics were changes in the level of HbA1c from baseline to follow-up periods, along with enumeration of lessons learned.

Results:

Of the 149 patients enrolled in the CGM program from January 20, 2022, to September 27, 2023, one opted out of sharing medical information and excluded from the analysis, with total of 148 participants. The demographics of participants included mean age of 54, self-identified race as non-white (40%), Hispanic or Latinx ethnicity (10%), and one-third uninsured (36%). Participants had diversity of language preferences, with Spanish (37%), English (35%), Somali (14%), and other languages (14%). The key clinical characteristics were an average Body Mass Index of 29.91 and the mean baseline Hemoglobin A1c was 9.73%. The results indicate that the CGM program reduced HbA1C levels significantly from baseline to first follow-up, and from baseline to second follow-up, but no significant difference between the first and second follow-up. During the implementation of the CGM program, several key lessons were identified from patient’s (education, financial, cultural and language barriers), organization’s (digital divide, interdisciplinary collaboration, patient motivation) and technical perspectives (interoperability needs, workflow integration, digital strategy).

Conclusions:

The pilot study demonstrated that CGM implementation at a FQHC is feasible, can improve the management of Diabetes in medically vulnerable and underserved populations, and help address the problem of health and digital inequity. But challenges such as technological and financial barriers need to be addressed along with an overarching digital strategy for equity. These lessons have implications for future scalability and sustainability of CGM and overarching remote patient monitoring programs.