Adults with diabetes who initiated continuous glucose monitoring (CGM) in a primary care setting experienced significant improvements in A1c levels and lower rates of hospitalization and emergency department (ED) visits compared with controls, based on new data.<\/p>\n
CGM is now the standard of care recommended by the American Diabetes Association for anyone with insulin<\/a>-treated diabetes, but CGM adoption in primary care lags well behind the evidence, said Jovan Milosavljevic, MD, MS, an endocrinologist and assistant professor of medicine at Albert Einstein College of Medicine in Bronx, New York. Although most diabetes management occurs in primary care, the impact of introducing CGM in this setting remains unclear, he said.<\/p>\n In a study published<\/a> in JAMA Network Open, Milosavljevic and colleagues compared data from diabetes patients who initiated CGM in a primary care setting with those who did not. The primary outcomes were changes in A1c levels and rates of hospitalization and ED visits.<\/p>\n The study population included 8502 adults aged 18 years or older with any insulin-treated diabetes who had at least one prescription for insulin and at least one primary care visit between August 1, 2022, and August 1, 2025, at one of 18 primary care clinics within the Montefiore Medical Center Health System.<\/p>\n The mean age of the participants was 62.3 years, and 56.0% were women; 42.6% and 33.6% had Medicare and Medicaid coverage, respectively. Approximately 46% of the patients were Hispanic and 35% were non-Hispanic Black.<\/p>\n Overall, 2392 patients (28.1%) were prescribed CGM by a primary care clinician. These patients tended to have higher baseline A1c levels and more microvascular complications; they also were younger and more likely to be English speakers with commercial insurance.<\/p>\n After 12 months, patients who initiated CGM in primary care had greater decreases in A1c levels than control participants, with a mean change of 0.66 percentage points (95% CI, 0.57-0.75) vs 0.17 percentage points (95% CI, 0.08-0.27) and a between-group difference of -0.49 percentage points (95% CI, -0.62 to -0.35).<\/p>\n Initiation of CGM in primary care also was associated with a 13% reduction in risk for recurrent all-cause hospitalizations (hazard ratio [HR], 0.87; 95% CI, 0.77- 0.98) and an 18% lower risk for recurrent ED visits (HR, 0.82; 95% CI, 0.74-0.91).<\/p>\n Although initiation of CGM in primary care remains modest (28.1% of eligible patients in this study), it is an improvement over findings from a previous study<\/a> in which 17% of diabetes patients received prescriptions for CGM in primary care, the researchers noted.<\/p>\n The findings were limited by several factors including the use of electronic health records and the potential for residual confounding, as well as the use of CGM prescriptions rather than confirmed device use to define exposure.<\/p>\n However, the results support greater adoption of CGM in primary care settings as a way to expand access to diabetes management technology and reduce healthcare costs, especially in underserved and ethnically diverse populations, the researchers noted. Additional research is needed to develop strategies to increase CGM initiation, including clinician training and patient education, they concluded.<\/p>\n The positive impact of CGM is well known in endocrinology settings, and the similarly positive effects with initiation in primary care were not unexpected, said Milosavljevic.<\/p>\n