Pharmacist-Led CGM Workflow Could Help Improve Diabetes Outcomes
A study found that a continuous glucose monitor workflow led by a pharmacist led to reduced HbA1c levels.
A personal continuous glucose monitor (CGM) workflow led by a pharmacist could significantly improve outcomes in patients with diabetes, according to research published in the Journal of the American Pharmacists Association.1 The authors of the study said the findings demonstrate the importance of pharmacists in medical care teams.
Pharmacist-Led CGM Workflow Could Help Improve Diabetes Outcomes / Andrey Popov - stock.adobe.com
In the United States, over 38 million adults have diabetes and an estimated 97.6 million have pre-diabetes.2 The prevalence of diabetes is also expected to continue growing, with research estimating 54.9 million Americans will have the condition by 2030.3 The use of CGMS in patients with diabetes has increased substantially and research has demonstrated their positive impact on diabetes management. CGMs have been shown to improve HbA1c, time in target blood glucose range and minimize time below target range.1
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“The available data signify that use of CGMs improves diabetes management and minimizes the risk of hypoglycemic events,” the authors wrote. “Despite increased use, follow-up with patients who use personal CGMs is a challenge in primary care settings. The lack of personnel to download and interpret results combined with the lack of time to review results creates challenges to maximize the benefits of CGM therapy and implement indicated medication changes.”
Investigators from Atrium Health Cabarrus in North Carolina conducted a study to evaluate a pharmacist-led personal CGM workflow and its impact on glycemic management in patients with diabetes. The pilot study focused on identifying and implementing strategies that have been used within the health system to increase the utilization of CGM and improve diabetes management.
The study was conducted at North Charlotte Medical Specialist Internal Medicine Clinic between October 2021 and April 2022. It included a medical care team consisting of 2 medical doctors, 5 physician assistants, 2 nurse practitioners, and 1 clinical pharmacist. As part of the CGM workflow, pharmacists conducted an initial chart review, reviewed patient CGM data, and implemented any indicated therapy changes.
Follow-up depended on the pharmacist’s discretion and ranged anywhere from 1 to 12 weeks. The CGM workflow also included billing for interpretation and teaching patients about proper CGM use. The primary study outcome was change in mean HbA1c, with secondary outcomes including change in diabetes-related hospitalization rate, medication changes implemented, number of billed 95251 charges and amount billed by the clinic.
The study cohort included 30 adult patients who had a diagnosis of diabetes and currently used a personal CGM. Of the patients, the average age was 66, 90% had type 2 diabetes, 7% had type 1 diabetes and 1 patient had a diagnosis of latent autoimmune diabetes in adults. In regard to type of CGMs, 80% of patients used a Libre2, 13% used a Dexcom G6 and 7% used a Libre 14 day.
Investigators found that the average HbA1c decreased to 7.1% from a baseline of 8.3% after the implementation of the CGM workflow. Out of the 30 patients, 22 saw an HbA1c improvement, with an average reduction of 2.1%. A total of 58 CPT 95251 incidences were billed, yielding $7052 in billed CGM services. During the course of the study, 100 medication changes were implemented by the clinical pharmacist. One patient had a diabetes-related hospitalization, compared to 2 patients in the 6 months before the CGM workflow was initiated.
“Clinical pharmacists are recognized as vital members of medical care teams to optimize patient outcomes,” the authors concluded. “Pharmacists support other providers by conducting comprehensive medication reviews, optimizing medications, offering adherence techniques, advocating for personalized treatment plans, and enhancing patient follow-up frequency…The creation of a pharmacist-led personal CGM workflow not only increases the value of the pharmacist on the health care team but also leads to a higher quality of patient care based upon the findings of the primary outcome within this study.”
READ MORE: Diabetes Resource Center
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