Study: Continuous glucose monitoring at the primary care level can be effective

A new study from the University of Colorado and published in BMC Primary Care found that primary care practices adoption of continuous glucose monitoring (CGM) for diabetes care can be effective even when resources are limited.

The research, part of the PREPARE 4 CGM study, examined how 76 primary care practices chose to implement CGM—a wearable technology that tracks blood sugar levels in real time. CGM has been shown to improve blood sugar control and enhance quality of life for people with diabetes. Yet despite endorsements from the American Diabetes Association, uptake of the technology in primary care has lagged behind its use in endocrinology.

In the study, 46 practices chose to implement CGM on their own using a self-paced model with educational modules, while 30 opted to refer patients to a virtual service that helped initiate CGM and interpret the results.

A key factor influencing this decision was access to a Certified Diabetes Care and Education Specialist (DCES). All practices with a DCES on staff chose the self-implementation model. None of the practices that used the virtual service had a DCES.

“This highlights the important role DCESs can play as champions of diabetes technology in primary care,” the authors wrote. “But for practices without that expertise in-house, a virtual support option can help close the gap.”

Diabetes affects more than 38 million people in the U.S.—about one in nine Americans—and nearly half of them are not meeting blood sugar goals, according to the Centers for Disease Control and Prevention. CGM, which replaces the need for frequent fingersticks, has been shown to reduce A1C levels and improve patients' understanding of how food and behavior affect their diabetes.

Most people with type 2 diabetes and many with type 1 are treated in primary care settings, not by endocrinologists. Yet only 39% to 44% of primary care clinicians have ever prescribed CGM. Barriers include lack of insurance coverage, paperwork burdens, and limited staff or technology expertise.

The findings suggest that both self-implementation and virtual facilitation are viable ways to expand access to CGM—particularly in rural or underserved areas where specialty care is harder to reach.

“Offering multiple models of support may be key to ensuring more patients benefit from this life-changing technology,” the study concluded.