Examining Impact of Continuous Glucose Monitors on Diabetes | ASHP Midyear

Over 38 million adults in the United States have diabetes and an estimated 97.6 million have pre-diabetes.¹ By the year 2030, the prevalence of diabetes is expected to increase significantly, with research estimating that more than 54 million Americans will have the condition.² Continuous glucose monitors (CGM) have been shown to improve HbA1c, time in target range, and minimize time below range in patients with diabetes. Although the use of CGMs has increased substantially since their introduction, several barriers remain that inhibit their adoption.

Examining Impact of Continuous Glucose Monitors on Diabetes | ASHP Midyear / stivog- stock.adobe.com

At the American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition, held December 8 to 12 in New Orleans, Louisiana, 2 posters presented at the meeting looked deeper into the topic of CGMs, comparing the devices to traditional glucose monitoring and examining the impact of a pharmacist driven CGM education service within primary care.

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In the first poster, investigators from Ascension Saint Francis conducted a study to examine the impact of CGM on diabetes outcomes for patients who are managed by an ambulatory care pharmacist.³ The multi-center, randomized, retrospective chart review collected data from 4 pharmacist-run pharmacotherapy clinics in Chicago, Illinois and compared 2 groups of patients: patients using CGM and those using traditional glucose monitors.

The study cohort included 44 adult patients with diabetes who had at least 2 clinic visits between HbA1c draws, follow-up HbA1c at least 2 months from their initial visit, and follow-up HbA1c less than 6 months from their initial HbA1c draw. For patients using CGM, additional inclusion criteria included having been using CGM for at least 2 months and having access to CGM reports. The primary study endpoint was the percent change in HbA1c from baseline clinic enrollment or CGM initiation to first follow-up HbA1c.

The study found that the mean percent change in HbA1c from baseline to the first follow-up was -1.07% for the CGM group and -1.94% for the traditional glucose monitor group over a 4 month average. Only small changes were seen between baseline and the first follow-up for the average time in range, average time below range, average blood glucose and average coefficient of variation for the CGM group. Additionally, 2 patients in the CGM group visited an emergency department or were hospitalized, compared to 1 in the traditional group.

“The use of CGM devices did not improve diabetes outcomes when compared to traditional glucose monitors for patients managed by a pharmacist-run clinic,” the authors concluded. “Traditional glucose monitors were associated with numerically better improvements in hemoglobin HbA1c compared to CGMs. The largest improvements in hemoglobin HbA1c for the CGM group was observed in patients initiated on a CGM device within 3-6 months of pharmacotherapy clinic enrollment.”

In the second poster, investigators from Nebraska Medicine conducted a study to assess a pharmacist-led CGM education service within a patient-centered medical home primary care clinic.⁴ For the study, a workgroup of ambulatory care pharmacists, who were led by a post-graduate year 2 ambulatory care pharmacy resident, implemented device-specific education sessions and provided resources to standardize CGM education on common devices that are available commercially.

The program’s educational sessions focused on CGM device use, troubleshooting, set-up, and patient education. Additionally, an order panel was created to help improve access to CGMs, and make it easier for providers to order CGM devices and referral for pharmacist education.

From May 2023 to May 2024, 216 CGM education session had been conducted by pharmacists at the medical home. The program has improved CGM education and CGM data access, and has also increased provider education and overall patient access. The authors said that the next focus of the program will be “to create a standardized form for CGM ambulatory glucose profile data reporting and pharmacist outreach tracking.”

READ MORE: Diabetes Resource Center

Follow along with our coverage of the 2024 ASHP Midyear Clinical Meeting and Exhibition here.

References

1. National Diabetes Statistics Report. Report. CDC. May 15, 2024. Accessed November 14, 2024. https://www.cdc.gov/diabetes/php/data-research/index.html

2. Rowley WR, Bezold C, Arikan Y, et al. Diabetes 2030: Insights from Yesterday, Today, and Future Trends. Popul Health Manag. 2017 Feb;20(1):6-12. doi: 10.1089/pop.2015.0181. Epub 2016 Apr 28. PMID: 27124621; PMCID: PMC5278808.

3. McKnight GN, Lapkus MK, Spring CN, et al. Comparing Continuous and Traditional Glucose Monitoring on Diabetes Outcomes in a Pharmacist-Managed Clinic. Presented at: American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition; December 8-12, 2024; New Orleans, LA. Poster 4-009.

4. Schwenka NC, Trueman C, Chang C, et al. Implementation of Pharmacist-Driven Continuous Glucose Monitor (CGM) Education Service Within Primary Care. Presented at: American Society of Health-System Pharmacists 2024 Midyear Clinical Meeting and Exhibition; December 8-12, 2024; New Orleans, LA. Poster 8-006.