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. 2021 May;15(3):539-545.
doi: 10.1177/1932296821998724. Epub 2021 Mar 10.

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

Gregg D Simonson  1 , Richard M Bergenstal  1 , Mary L Johnson  1 , Janet L Davidson  1 , Thomas W Martens  1
Affiliations

Effect of Professional CGM (pCGM) on Glucose Management in Type 2 Diabetes Patients in Primary Care

Gregg D Simonson et al. J Diabetes Sci Technol. 2021 May.

Abstract

Background: Little data exists regarding the impact of continuous glucose monitoring (CGM) in the primary care management of type 2 diabetes (T2D). We initiated a quality improvement (QI) project in a large healthcare system to determine the effect of professional CGM (pCGM) on glucose management. We evaluated both an MD and RN/Certified Diabetes Care and Education Specialist (CDCES) Care Model.

Methods: Participants with T2D for >1 yr., A1C ≥7.0% to <11.0%, managed with any T2D regimen and willing to use pCGM were included. Baseline A1C was collected and participants wore a pCGM (Libre Pro) for up to 2 weeks, followed by a visit with an MD or RN/CDCES to review CGM data including Ambulatory Glucose Profile (AGP) Report. Shared-decision making was used to modify lifestyle and medications. Clinic follow-up in 3 to 6 months included an A1C and, in a subset, a repeat pCGM.

Results: Sixty-eight participants average age 61.6 years, average duration of T2D 15 years, mean A1C 8.8%, were identified. Pre to post pCGM lowered A1C from 8.8% ± 1.2% to 8.2% ± 1.3% (n=68, P=0.006). The time in range (TIR) and time in hyperglycemia improved along with more hypoglycemia in the subset of 37 participants who wore a second pCGM. Glycemic improvement was due to lifestyle counseling (68% of participants) and intensification of therapy (65% of participants), rather than addition of medications.

Conclusions: Using pCGM in primary care, with an MD or RN/CDCES Care Model, is effective at lowering A1C, increasing TIR and reducing time in hyperglycemia without necessarily requiring additional medications.

Keywords: glucose management; primary care; professional continuous glucose monitoring; quality improvement; type 2 diabetes.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: GDS has received unrestricted educational grants from Abbott Diabetes Care and Medtronic and is on the scientific advisory board for Merck. GDS receives no personal income from these relationships and all funds and honorariums go directly to support the mission of the non-profit International Diabetes Center.

RMB has received research support, consulted, or has been on a scientific advisory board for Abbott Diabetes Care, Ascensia, CeQur Corporation, DexCom, Hygieia, Insulet, Johnson & Johnson, Lilly, Medtronic, Novo Nordisk, Onduo, Roche, Sanofi and United Healthcare. His technology research is funded in part by NIH/NIDDK. RMB’s employer, non-profit HealthPartners Institute, contracts for his services and no personal income goes to RMB.

JLD reports no conflicts of interest.

MLJ has received research support from Abbott Diabetes Care, CeQur Corporation, DexCom, Hygieia, Insulet, JDRF, Lilly, Medtronic, NIH/NIDDK, Novo Nordisk, and Sanofi. MLJ’s employer, non-profit HealthPartners Institute, contracts for her services and no personal income goes to MLJ.

TWM is personally involved in a number of industry funded or sponsored research studies with Dexcom, Medtronic, Abbott Diabetes Care, Insulet, Novo-Nordisk, and Eli Lilly. His employer, non-profit HealthPartners Institute, contracts for his services and no personal income goes to TWM.

Figures

Figure 1.
Figure 1.
MD Care Model pCGM primary care clinic process workflow.
Figure 2.
Figure 2.
RN/CDCES Care Model pCGM primary care clinic process workflow.
Figure 3.
Figure 3.
Change in A1C in MD Care Model.
Figure 4.
Figure 4.
Change in A1C in RN/CDCES Care Model.
Figure 5.
Figure 5.
Interventions after pCGM.
Figure 6.
Figure 6.
Number of medications before and after pCGM.
See this image and copyright information in PMC

References

    1. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-853. - PubMed
    1. Gerstein HC, Miller ME, Byington RP, et al.. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545-2559. - PMC - PubMed
    1. Kazemian P, Shebl FM, McCann N, Walensky RP, Wexler DJ. Evaluation of the cascade of diabetes care in the United States, 2005-2016. JAMA Intern Med. 2019;179(10):1376-1385. - PMC - PubMed
    1. Edelman SV, Polonsky WH. Type 2 diabetes in the real world: the elusive nature of glycemic control. Diabetes Care. 2017;40(11):1425-1432. - PubMed
    1. Chehregosha H, Khamseh ME, Malek M, Hosseinpanah F, Ismail-Beigi F. A view beyond HbA1c: role of continuous glucose monitoring. Diabetes Ther. 2019;10(3):853-863. - PMC - PubMed

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