Accepted for/Published in: JMIR Diabetes
Date Submitted: Nov 22, 2024
Open Peer Review Period: Dec 6, 2024 - Jan 31, 2025
Date Accepted: May 9, 2025
(closed for review but you can still tweet)
A Multidisciplinary Team Implementation of Continuous Glucose Monitoring in Primary Care: A Pilot Study
ABSTRACT
Background:
Continuous glucose monitoring (CGM) is used to assess glycemic trends and guide therapeutic changes for people with diabetes. We aimed to increase patient access to this tool by equipping primary care physicians (PCPs) to accurately interpret and integrate CGM into their practice via a multidisciplinary team approach.
Objective:
The primary objective of this study was to integrate CGM into a primary care practice utilizing physician extenders, including a clinical pharmacist (PharmD) and Certified Diabetes Care and Education Specialist (CDCES).
Methods:
Eighteen PCPs received a one-hour video training module from an endocrinologist teaching a systematic stepwise approach to CGM interpretation. Patient inclusion criteria included type 2 diabetes mellitus (T2DM), ≥18 years old, hemoglobin A1c (HbA1c) ≥ 8% or concern for hypoglycemia, without past CGM use or an endocrinology visit in the past year. Patients saw physician extenders (CDCES and/or a PharmD) for diagnostic CGM placement and education on nutrition, medication administration, and physical activity goals based on the PCP’s recommendations. The CDCES or PharmD reviewed CGM data with patients and collaborated with PCPs to adjust the care plan, informed by the systematic stepwise approach to CGM interpretation taught to the PCPs. Patients either converted to personal CGMs if desired or had a second professional CGM placed ≥ 1 month from the diagnostic and obtained a post-intervention HbA1c ≥ 3 months from the initial HbA1c measurement. Follow-up continued with the CDCES and/or PharmD until patients met the study discharge criteria of HbA1c ≤ 7%.
Results:
CGM users (n=46) were [mean (SD)] 62.39 (±14.57) years of age and 30.43% female. Time in range (TIR) increased by 28.06% from 43.25% (±33.41) at baseline to 71.31% (±25.49) post-intervention (P <.001), due to reduced hyperglycemia (Table 2). The proportion of CGM users meeting the consensus target of TIR ≥70% increased from 23.81% to 57.14% (P<.001). Post-intervention, HbA1c decreased an average of 2.37 from 9.68 (±1.78) to 7.31 (±1.32) (P<.001).
Conclusions:
Integration of CGM into primary care clinics to increase patient access is feasible and effective using a multidisciplinary approach.
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