Patient and Provider Perspective on Impact of Professional Continuous Glucose Monitors on Diabetes Control in a Complex Care Population

Abstract

Purpose: While numerous studies have shown that continuous glucose monitors (CGMs) improve management for patients with diabetes, there has been little focus on the efficacy of this technology in medically, socially and behaviorally complex patients, with numerous barriers to treatment compliance. Methods: This is a retrospective cohort study of patients dually-eligible for Medicare and Medicaid enrolled in a professional CGM pilot. Chart review was conducted to determine CGM application dates and pre- and post-CGM HbA1c. Surveys were conducted with both patients and providers to determine impressions of CGM and its impact. Results: A total of 13 patients were enrolled in the study, all with a behavioral health history, varying levels of physical disability, and multiple medical comorbidities (average: 14.5). Average pre-HbA1c was 9.4 with a post-CGM change of -0.48 (p=0.38). Patient survey data revealed that the majority found professional CGM useful (88%) and that it changed how they viewed their diabetes (63%). Provider survey data similarly revealed that a majority found that CGM use led to improved clinical outcomes in this complex patient cohort (64%). Qualitative analysis of provider survey data revealed 5 themes that could guide CGM utilization in this patient population. Conclusions: This study showed no statistically significant change in HbA1c after CGM use. It did reveal strong patient and provider preferences for CGM driven by the device providing more data and increasing patient engagement. These results suggest that CGM devices can be appropriate tools for diabetes management in complex patient populations.