358-OR: Remote CGM Monitoring in People with Type 2 Diabetes (T2D) in an Under-resourced Setting

Objective: To implement CGM and remotely monitor patients with T2D treated in a safety net clinic to allow for patient outreach between routinely scheduled visits and provide feedback to health care providers (HCP’s) for algorithm-based medication management.

Methods: Patients were provided a Libre 2 CGM and followed via LibreView. Baseline clinical data and AGP’s were evaluated by the PI and management recommendations were sent to the patient’s HCP. Project staff reviewed the LibreView portal daily and contacted subjects who had glucose values either above 250 mg/dl or below 70 mg/dl more than 5% of the time and provide diabetes education. Clinical data updates and AGPs were sent to the PI based on need (from weekly to monthly) so additional diabetes management recommendations could be provided. Measures administered at baseline, 6 months and 12 months were assessed for Shapiro-Wilk normality and paired dependent t-tests. A 2-sided alpha of 0.05 was used.

Results: Interim results of 137 of 200 enrolled subjects (52 not on insulin and 85 on insulin) showed improvements in the following measures from baseline to 6 months: Mean baseline A1C = 9.0% decreased to 7.8% by 6 months (-1.2 +/- 1.7 (SD), p<.001). TIR mean increase was 12.5 +/- 27.7 (SD), p<.001. GMI was reduced by -.591 +/- .59, p<.001. A slight reduction in depression was seen -0.847 +/- 4.6 (PHQ8, p= .036). Diabetes Distress Scale (DDS) showed reduced stress for non-insulin users -1.23 +/- 3.5, p= .012 and for insulin users -2.8 +/- 4.6, p = .005. HCPs implemented recommendations 75% of the time and use of GLP-1 RA’s doubled, based on recommendations sent to HCP’s. Analysis of 91 subjects who completed 12 months show sustained outcomes.

Conclusions: Remote monitoring coupled with education and medication recommendations provided to HCPs improved diabetes outcomes in people with T2D, on insulin and non-insulin therapies.