Background: Professional continuous glucose monitoring (proCGM) can be used sporadically for patients who do not meet criteria for Personal CGM. The interdisciplinary nature of primary care teams from Veterans Affairs Community Based Outpatient Clinics (CBOCs) represents a good opportunity for implementation of proCGM technology to improve glycemic control. Objectives: To assess treatment changes prompted by proCGM implementation.
Methods: Veterans with suboptimal glycemic control (A1c >7.5% or hypoglycemia) who did not qualify for a personal CGM had a proCGM placed during office visit. Two weeks later, the proCGM was downloaded during a follow-up visit and changes were implemented as needed.
Results: Thirty-eight sensors were placed in 36 patients (two patients repeat after sensor fell off) seen by clinical pharmacists from 5 CBOCs from North Florida/South Georgia VA Health System. Baseline A1c was 8.1% (SD 1.3), proCGM data was available in 91% of patients. Mean duration of sensors was 13 days (SD 3.3). In 36% of patients, there was insulin de-intensification, mainly because of hypoglycemic events. In 6% of patients, an oral agent was discontinued because their time in range was above 90% and side effect profile (weight gain). About 18% of veterans needed insulin intensification, either adding short acting insulin or increasing basal insulin. Overall, significant treatments changes were implemented in 60% of patients, thus, avoiding clinical inertia. High glucose variability (% coefficient of variation >33%) was present in 45% of veterans and two thirds of them required de-intensification of their insulin regimen due to hypoglycemia.
Conclusions: Implementation of proCGM in primary care clinics led to treatment changes in 60% of patients. This improvement project demonstrated feasibility of deploying new diabetes technologies in primary care setting.
K.Saren: None. A.L.Raulerson: None. S.Finch: None. J.A.Leey: None.
U.S. Department of Veterans Affairs Office of Rural Health