Continuous glucose monitor (CGM) use is known to improve glycemic outcomes for patients with Type 1 Diabetes, but uptake is not universal in the pediatric population. We hypothesized that requiring standardized documentation of CGM use and identification of barriers would increase awareness and identify potential targets for future interventions, ultimately increasing CGM use in our population. We designed standard documentation within the electronic medical record for outpatient visits to assess CGM use and barriers to use. The documentation collects data on CGM possession, %time in use, prescriptions, and barriers to use in patients with Type 1 Diabetes. Our intervention involved integrating the standard CGM documentation into diabetes note template thus automating completion by providers. Data was pulled from clinic days two weeks prior to intervention (100 patients) and another days, two months after intervention (74 patients) . Before intervention 83% of patients had a CGM compared to 87% of patients after intervention (p=0.51) . While 63% used a CGM >70% of the time before intervention, 73% of patients had >70% use post intervention (p=0.19) . Provider documentation was not universal with 12% and 4% of encounters with no documentation of time in use before and after intervention respectively. After standardization 7/patients without a CGM were prescribed one during the visit compared to 5/17 of patients prior. Barriers identified included (n) : insurance coverage (4) , skin adhesion/issues (3) , self-image (2) , lack of education /distrust (1) , technological issues (1) , resistance to wearables (1) , and other (3) . Our patient population had a high rate of CGM use. Two months after the intervention, both use of CGM and new prescriptions increased. The improvement may be related to increased awareness and addressal of CGM barriers among providers. The intervention provided insight on barriers to CGM use, such as skin/adhesion issues, that will be targeted for future improvement.
S.E.Delacey: None. N.J.Sullivan: None. N.R.Fogel: None.
National Institute of Diabetes and Digestive and Kidney Diseases Ruth L. Kirschstein National Research Service Award T32 DK007169 and T1D Exchange