Background: Continuous glucose monitors (CGM) provide clearer, more actionable data than self-monitoring of blood glucose and are associated with improved outcomes (e.g., reduced HbA1c) . Barriers to endocrinology care create disparities in CGM access. Expanding CGM use in primary care can improve outcomes and reduce disparities. We explored barriers and facilitators to CGM use in primary care.
Methods: Mixed-methods sequential explanatory study of U.S. primary care clinicians, with survey (n=632) followed by semi-structured interviews (n=55) .
Analysis: Multivariable linear and logistic regression, followed by rapid qualitative analysis of interviews to offer a deeper understanding of quantitative data.
Results: Qualitative analysis helped explain quantitative findings that residents were less likely than others to have prescribed CGM but had greater intent to prescribe: lack of resident knowledge about CGM hindered prescribing. While quantitative analysis found clinicians >40 miles from endocrinologists were somewhat more likely to prescribe CGM (coef .18, p=.041) , qualitative analysis offered nuance: results were mixed, with many interviewees noting distance as a barrier due to having no endocrinologist to help manage the CGM; for others, proximity was a barrier because they referred patients to endocrinology for CGM rather than prescribing themselves. While survey results showed an association between higher proportion of Medicare patients and greater confidence in using CGM to manage diabetes, qualitative themes around prescribing barriers included lack of public insurers covering CGM, suggesting that, for some, having Medicare may make CGM prescription more difficult.
Conclusion: Primary care clinicians can benefit from education and support for CGM use. Targeting recent trainees and clinicians in regions lacking endocrinology could increase CGM use, extending its benefits to more people with diabetes.
T. Oser: Advisory Panel; Cecelia Health, Dexcom, Inc. T. Hall: None. M.K. Warman: None. M.K. Filippi: None. B. Manning: None. E. Callen: None. L. Dickinson: None. L.C. Michaels: None. S. Oser: Advisory Panel; Cecelia Health, Children with Diabetes, Inc., Dexcom, Inc. Consultant; American Diabetes Association, Association of Diabetes Care & Education Specialists, Jaeb Center for Health Research. Research Support; American Academy of Family Physicians, Leona M. and Harry B. Helmsley Charitable Trust.
The Leona M. and Harry B. Helmsley Charitable Trust