360-OR: Defining New Targets for Interventions to Increase Continuous Glucose Monitoring (CGM) Use in Primary Care

Background: CGM is a standard of care for diabetes management, yet its adoption in primary care remains limited where the majority of people with diabetes are served. Examining contributors to CGM prescriptions in primary care may identify new targets for intervention that could improve diabetes population health.

Methods: We examined CGM prescription behaviors of primary care providers within a large safety net hospital in the Bronx, NY. We extracted data from the electronic health record on all adults ≥18 years with type 2 diabetes and at least one primary care visit from July 31, 2020, to July 31, 2023. We used competing risk regression to model factors associated with CGM prescription.

Results: Out of 40,791 people with type 2 diabetes (mean age 62 years, 60% female, 39% Hispanic, 39% Non-Hispanic Black, 77% English-speaking, 47% publicly insured, 27% seen by trainee physicians), 4,129 (10.1%) were prescribed CGM. CGM was 40% less likely to be prescribed for Spanish vs. English-speaking (SHR 0.60 [0.54-0.68]), 15% less likely with public insurance (SHR 0.85 [0.79-0.91]), and 25% less likely with diabetes complications (microvascular SHR 0.73 [0.67-0.79], macrovascular SHR 0.77, [0.69-0.86]). Conversely, CGM was 30% more likely to be prescribed with each additional HbA1c percentage point (SHR 1.31 [1.30-1.34]) and 6% more likely with each additional prescriber year of experience (SHR 1.06, [1.05-1.07]). CGM prescriptions increased in a dose-response manner with treatment intensification (non-insulin SHR 2.08 [1.76, 2.46]; basal insulin SHR 3.94 [3.27-4.75]; multiple daily insulin SHR 5.03 [4.17-6.07]).

Conclusion: Our analysis of a large primary care network of people with diabetes can inform strategies to support more widespread CGM use in primary care. New targets could include Spanish language support services; aid for better prior authorization procedures for public insurance; and increased education of CGM benefits for providers with less years of experience.