Use of continuous glucose monitoring to improve glycemic management: A clinician's guide

Self Cite

IntroductionDiabetes self‐management education and support and professional continuous glucose monitoring (CGM) were combined into shared medical appointments (SMA) to provide care for people with diabetes. Although the individual components have evidence of efficacy, this combination has never been studied.ObjectivesThe purpose of this study is to assess the impact of CGM SMA on diabetes self‐efficacy and hemoglobin A1C (A1C) in persons with diabetes.MethodsAdults who attended a two‐part CGM SMA at a large academic medical center were included in this retrospective, pre‐post study. The CGM SMA incorporated diabetes education, peer support, and seven days of professional CGM. The primary outcome was change in diabetes self‐efficacy through a validated eight‐item Likert Scale instrument. Secondary objectives were changes in A1C, changes in diabetes medications, and type of planned lifestyle changes. Paired t tests were used to analyze change in A1C and diabetes self‐efficacy scores.ResultsA total of 171 participants were included in this analysis. Diabetes self‐efficacy scores increased by a mean of 1.63 ± 2.09 points (P < .001) out of 10 points maximum after participation in the two‐part CGM SMA. The A1C decreased by a mean of 0.80 ± 1.52% (P < .001), with a mean follow‐up A1C of 7.8 ± 1.60%. Those with an A1C > 8% (n = 101) experienced a decrease of 1.20%. Participants utilizing the unblinded device (n = 133) experienced a decrease in A1C by 0.75% compared with 1.0% in those that utilized a blinded device (n = 38). Most medication changes made in the CGM SMA were dosage adjustments and changes in administration time.ConclusionsThe CGM SMA is a novel practice model incorporating diabetes education, peer support, professional CGM, and interprofessional care that demonstrated improvements in diabetes self‐efficacy and A1C.

Section: Discussionmentioning

confidence: 99%

“…The average reimbursement for CPT 95250 and 952 ranges from $189 to $400 per person. This can also be billed concurrently with DSMES 31 …”

Section: Discussionmentioning

confidence: 99%

Continuous glucose monitoring shared medical appointments improve diabetes self‐efficacy and hemoglobin A1C

Simonyan

Isaacs

Lekic

et al. 2021

Self Cite

“…1,3,7 Several studies demonstrate that pharmacist CGM integration resulted in improvement in clinical outcomes. [8][9][10][11][12] These clinical improvements include improved patient self-efficacy in managing diabetes and A1C reduction. Other studies detail the role of the pharmacist as part of the multidisciplinary team in managing insulin pumps during routine clinical care as well as transitions of care which may include activities such as policy development, patient monitoring, and postdischarge education.…”

Section: Evidence Of Pharmacist Involvement With Diabetes Technologymentioning

confidence: 99%

Diabetes technology: A primer highlighting the role of the pharmacist

Hess

Schumacher

Whitley

et al. 2022

Self Cite

The rapid advancement of technology has ushered in a new era of diabetes management, especially with regard to continuous glucose monitoring (CGM) and insulin delivery systems. Technology is changing at a fast pace and these tools can be unknown or confusing to people with diabetes. Pharmacists can play a major role in reducing barriers and facilitating shared decision‐making regarding the individualization of technology in diabetes care. The Endocrine and Metabolism PRN Research Committee solicited the PRN membership to draft an opinion paper on diabetes technology using the Identify‐Configure‐Collaborate (ICC) framework from the Association of Diabetes Care and Education Specialists. The primary goal of the opinion paper is to provide an educational primer to health care professionals interested in learning more about the emerging diabetes technology landscape and highlight the role of the pharmacist within the ICC framework.

“…The use of professional CGM can also be beneficial in identifying and correcting patterns of hyperglycemia or hypoglycemia and improving A1c levels in persons with diabetes on non-insulin regimens as well as basal-only insulin regimens. 4 Professional CGM allows the practitioner to make well-informed medication adjustments based on the patient's daily glycemic patterns.…”

Section: Introductionmentioning

confidence: 99%

“…It also serves as an opportunity for persons with diabetes to review their ambulatory glucose profile (AGP) report, associate their glucose patterns with medication‐taking, dietary modifications, and physical activity and experience what it is like to wear a device before considering personal CGM. The use of professional CGM can also be beneficial in identifying and correcting patterns of hyperglycemia or hypoglycemia and improving A1c levels in persons with diabetes on non‐insulin regimens as well as basal‐only insulin regimens 4 . Professional CGM allows the practitioner to make well‐informed medication adjustments based on the patient's daily glycemic patterns.…”

Section: Introductionmentioning

confidence: 99%

Describing the application and barriers of pharmacist‐led professional continuous glucose monitoring in the ambulatory care setting

Nimer

Schumacher

Bolch

2021

Self Cite

Introduction: Advances in technology for continuous glucose monitoring (CGM) contribute to the care of persons with diabetes and CGM systems are recommended in multiple guidelines. There are limited studies describing CGM use by clinical pharmacists in the ambulatory care setting. Objectives: The primary objective of this study is to identify and describe the current use, application, and barriers of CGM by clinical pharmacists in the ambulatory care setting. Secondary objectives include identifying the prevalence of professional CGM use by clinical pharmacists, recognizing specific barriers faced by pharmacists when implementing professional CGM into clinical practice, and determining interest in professional CGM implementation by ambulatory care pharmacists as an alternative for patients unable to afford personal CGM. Methods: This was a self-administered, voluntary, web-based questionnaire distributed to 2207 ambulatory care pharmacists. Questions were stratified to identify the clinical use and barriers for those who do and do not use professional CGM, respectively. The survey was active for 9 weeks and results from the survey were analyzed based on question type. Results: One hundred and eighty five survey responses were included in the study results. Most participants (70.8%) indicated currently working in a primary care clinic, and 8.1% indicated working in an endocrinology office. Results identified that 18.9% of participants use personal CGM and 35.1% use professional CGM to facilitate the management of persons with diabetes. The most common barriers to professional CGM implementation include lack of funding for startup costs (65.9%), lack of time for device placement and result interpretation (45.8%), and unpredictable patient follow-up (48.3%). Conclusion: Study participants indicated that the majority of patients they manage have diabetes; however, lack of education and training on device use, data interpretation, and reimbursement opportunities were commonly cited barriers to CGM use. Additional training opportunities should be considered to facilitate the implementation of CGM by ambulatory care pharmacists into clinical practice.