Community Pharmacists Could Help Patients Control Diabetes Through Remote CGM Monitoring

A remote continuous glucose monitor (CGM) monitoring service that’s led by community pharmacists may help improve glycemic metrics for patients with diabetes, according to research published in the Journal of the American Pharmacists Association.¹ The authors said the program could improve diabetes control and reduce long-term diabetes-related health complications.

The prevalence of diabetes has been increasing in the United States and now represents a significant public health concern. Over 38 million people in the country—or around 11% of the population—have diabetes.² Although CGM technology is known to improve glycemic control and has been rapidly adopted, the prevalence of use is still below 50%.³ Cloud-based CGM monitoring platforms represent a new way for health care professionals to remotely monitor patients, but certain barriers have so far restricted their use.

“Community pharmacists routinely dispense and provide education on CGM devices,” the authors wrote. “There have been numerous studies proving that diabetes education programs at community pharmacies have a positive impact on patients’ diabetes control. However, the use of remote CGM monitoring has been traditionally reserved for ambulatory care or primary care clinics, and there is a lack of significant data supporting remote CGM monitoring in the community pharmacy.”

A team of investigators from the University of Cincinnati College of Pharmacy and Kroger Health conducted a study to evaluate the clinical impact of a community pharmacist-led remote CGM monitoring service on patients’ glycemic metrics. The prospective feasibility study took place at 2 pharmacies within a single large community pharmacy chain from November 2022 through June 2023.

READ MORE: Short-Term CGM for T1D More Effective Than Self-Monitoring Blood Glucose

Before the study began, the pharmacists involved completed an online CGM training module provided by the American Pharmacist’s Association. Two different cloud-based CGM platforms were used: Dexcom Clarity and FreeStyle LibreView. The study cohort included 36 adult patients who were identified through prescription dispensing reports for CGM devices in the pharmacy management system.

As part of the remote service, a pharmacist evaluated and recorded glycemic data from each patient at least every 2 weeks. If patient metrics reached certain criteria, the pharmacist would contact them via telephone. The pharmacist also reviewed medications, medication adherence, and provided medication therapy management services, including recommending dosage adjustments, initiation or discontinuation, and new CGM devices.

During the 3-month study period, investigators saw that all patient glycemic metrics improved, including statistically significant improvements in high time above range, time in range, and average glucose. CGM utilization among the patients also increased from 73.25% before study enrollment to an average of 81.40% after the study. Additionally, as part of the comprehensive care assessment and medication therapy management, 9 patients received at least 1 vaccine during the enrollment visit, with several patients receiving more than 1.

Study limitations include the small sample size, a population with moderately controlled diabetes, that remote CGM services may be difficult for an individual pharmacist to implement, occasional technology barriers on the remote platform, and the lack of a control group which limited the interpretation of results.

“Community pharmacists are more likely to interact with patients than any other health care professionals, and despite the small sample size, this study demonstrates a remote CGM monitoring service is feasible in this setting and may have a positive impact on diabetes management,” the authors concluded. “More research is needed on a broader scale to determine the most effective method to implement this service and service sustainability.”

READ MORE: CGM Resource Center

References

1. Beldon C, Rogers K, Johnson A, et al. Assessment of a Community Pharmacist Remote Monitoring Service in Patients Using Continuous Glucose Monitors (CGMs). J Am Pharm Assoc. 2024; 102106, ISSN 1544-3191. https://doi.org/10.1016/j.japh.2024.102106.

2. National Diabetes Statistics Report. Report. CDC. November 29, 2023. Accessed April 25, 2024. https://www.cdc.gov/diabetes/data/statistics-report/index.html

3. Karakuş KE, Sakarya S, Yeşiltepe Mutlu G, et al. Benefits and Drawbacks of Continuous Glucose Monitoring (CGM) Use in Young Children With Type 1 Diabetes: A Qualitative Study From a Country Where the CGM Is Not Reimbursed. J Patient Exp. 2021;8:23743735211056523. Published 2021 Dec 2. doi:10.1177/23743735211056523