Improving Diabetic Control with Continuous Glucose Monitoring

The continuous glucose monitor (CGM) is a powerful tool to engage patients and health care providers to successfully manage type II diabetes. The purpose of the study was to increase engagement and improve outcomes in patients with T2 diabetes in a family practice setting. This clinical design using continuous glucose monitors has improved quality measures, reduced hypoglycemic events, and increased patient engagement. It has also benefited the physicians, as they are better equipped to make data driven adjustments to patients’ medications and life style practices.
Our CGM project has been a collaboration among the physicians, chronic disease care manager nurse, the clinic supervisor RN, and the supply vendor. The goal was to enroll patients who were on at least one injection (insulin or GLP1), not to HbA1C goal, a newly diagnosed T2 diabetes patient, or a patient having hypoglycemic events. We have initially placed 70 CGMS to date and enrolled 35 patients in our study. The patient’s glucose levels were tracked through an online program which shows time in range, average glucoses, GMI (glucose management indicator similar to HbA1C), and average low glucose events per day. Patient satisfaction surveys were collected and pre-HbA1Cs were also compared to their 90 day HbA1c. The physician’s workflow was to identify the patient, manage medication adjustments, and submit billing codes. The RNs created a workflow for applying the sensor, ordering supplies, educating the patient, and evaluating the outcomes.
Our outcomes data included a reduction of HbA1C of 1.6%, improvement in time in range, a decrease in time above and below range, and a reduction of hypoglycemic events. The patients’ average glucose at the beginning of the study was 162 and at the end of 90 days was 142. The patient satisfaction surveys indicated that patients’ awareness of glucose levels increased to 4.8 out of 5 and the impact of changing their nutrition was 4.5 out of 5. Patients indicated they had improve dietary choices, increased their knowledge, and enjoyed the ease of use of the CGM. Our goal is to implement this practice in all primary care facilities in the Kootenai Health System and influence other organizations to adapt CGM use for T2 diabetic patients.