28 August 2024
4 minutes reading time
Key findings:
- A virtual CGM initiation service is possible for general practitioners’ practices.
- Practices that did not have a diabetes care and training specialist decided to implement a virtual CGM.
According to two speakers, primary care practices can successfully implement continuous glucose monitoring in patients with diabetes by using resources from the American Academy of Family Physicians or a virtual CGM initiation service.
Bonnie T. Jortberg
PCPs tend to have less training in using CGM than endocrinologists, according to Bonnie T. Jortberg, PhD, RDN, CDCES, associate professor in the department of family medicine, associate director of the practice innovation program and director of eLearning at the University of Colorado Anschutz Medical Campus. She said the lack of training could lead to a lack of use of CGM in diabetic patients under the care of a PCP. With CGM playing a larger role in diabetes care today, it’s critical for PCPs to find ways to implement the devices, Jortberg said during a presentation at the Association of Diabetes Care and Education Specialists annual meeting.
“Primary care has an opportunity to reach many more patients with diabetes, especially in rural areas of the U.S. where endocrinologists are scarce,” Jortberg told Healio. “I also think there is a trust between patients and their primary care practices, which is an ideal environment to encourage the use of CGM.”
In the PREPARE 4 CGM trial, 76 primary care physicians in Colorado participated in one of three interventions. Thirty practices chose to implement CGM using a virtual program that included a one-time CGM webinar and a virtual clinic that initiated CGM therapy for referred patients, provided training on its use, optimized device settings, and provided treatment recommendations. The other 46 practices used the American Academy of Family Physicians’ Transformation in Practice Series (TIPS) resources to implement CGM. The 46 practices that used TIPS were randomly assigned 1:1 to use the TIPS recommendations plus receive professional practice facilitation services to implement the guidelines or to use TIPS alone without additional services.
Sean M. Oser
“We chose three different strategies for CGM implementation for several reasons,” Sean M. Oser, MD, MPH, CDCES, associate professor in the department of family medicine, director of the practice innovation program and associate director of the primary care diabetes laboratory at the University of Colorado Anschutz Medical Campus, told Healio. “First, we know that primary care physicians can vary greatly and that choice is always helpful, especially since different practice factors can make one approach seem more feasible than another. We also wanted to make sure that all practices had a chance to experience CGM implementation, so even the least effortful strategy in the study still provides CGM implementation. We also wanted there to be a randomized element to allow for an extra-rigorous study, so allowing both choice and randomization meant we needed to offer three strategies.”
Diabetes educators are crucial for the introduction of CGM
The researchers examined practice management and demographic factors within the practices to examine associations with the choice of CGM implementation. Practices that had a diabetes care and education specialist on staff were more likely to choose the TIPS intervention than the virtual CGM clinic (X2 = 11.05; P
No other factors were associated with a practice’s decision to implement a CGM.
“We learned that the diabetes care and education specialist plays a central role in primary care,” Oser said during the presentation. “It was the only indicator of which implementation path would be chosen. We know that only 36% (of primary care practices) have one, and this is a great opportunity to demonstrate the value of the diabetes care and education specialist to clinical practice in primary care.”
Virtual CGM implementation possible
Oser said virtual CGM services may be best suited for practices that do not have a diabetes care and education specialist available. Practices in the virtual arm referred 193 patients to the virtual clinic. Of those patients, 99 were enrolled and 94 completed the clinic. Oser said preliminary results showed improvements in all CGM metrics among those referred to the virtual CGM clinic.
“In retrospect, we are glad that we offered several methods for this, because there is no one-size-fits-all solution,” said Oser.
According to Oser, educating PCPs about CGM was key to the virtual arm’s success. For the intervention to work, Oser said, virtual staff must educate practices about indications for CGM use, how to interpret CGM data and how to enter data into the electronic health record.
“Implementing the virtual service arm of the study was also an opportunity to test a novel method to help primary care providers initiate CGM in their patients while also providing information on how to initiate CGM in their own practice,” Jortberg told Healio.
Consider using a professional CGM
One of the biggest challenges for researchers, Jortberg said, was obtaining prescription approval for personal CGM devices. She said practices using TIPS recommendations have struggled with the approval process and reforms are needed to simplify the process.
Instead of starting immediately with a personal CGM, Jortberg suggested that practices first have their patients start with a professional CGM owned by the practice. She said professional CGMs require little to no insurance approval and can be purchased at a low cost.
“This turned out to be a real win-win situation for both the practices and the patients,” said Jortberg.
The data presented by Jortberg and Oser were preliminary; a final analysis is expected in early 2025. However, both presenters said they were encouraged by the study’s initial results.
“Our initial experience shows that all three implementation strategies work and increase CGM implementation in primary care,” Oser told Healio. “It remains to be seen whether and to what extent one strategy is more effective, as well as the relative cost-effectiveness of the strategies. We have all of this planned in our analysis for the coming months.”
Sources/Disclosures
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Jortberg B, et al. Abstract D08C. Presented at: ADCES24; August 9-12, 2024; New Orleans.
Announcement: The study was funded by the Leona M. and Harry B. Helmsley Charitable Trust. Jortberg reports receiving research funding from the Helmsley Charitable Trust. Oser reports receiving research grants from Abbott, Dexcom, Insulet, and the Helmsley Charitable Trust; he serves on the advisory boards of Ascensia, Blue Circle Health, Dexcom, and Sequel, for which he has made payments to his employer; and he serves on the board of directors of Blue Circle Health.
