Deleting Cookies: A Nurse-Physician Collaboration to Improve Patient Outcomes with CGM Monthly Monitoring

In a small academic endocrinology practice, a nurse-physician collaboration was started to increase the amount time in range (TiR) for patient’s glucose readings while decreasing the patient’s A1C. This is achieved by patients granting the clinic access to their uploaded continuous glucose monitor (CGM) readings. Traditionally, trends in patients’ glucose readings may only be brought to the provider’s attention during a crisis or an office visit which may be up to 12 months apart. The individual CGM manufactures have web-based tracking systems for their products. Patients are encouraged to sign-up with CGM manufactures’ website (Abbott’s Libreview, Dexcom Clarity, Medtronic Carelink, Tandem T-Connect) with a personal account and allow the tracking system to share that data with the clinic. This sharing of glucose readings is achieved by individual patients accepting the clinic’s invitation to share data. This shared data gives the provider access to glucose readings in between office visits and supports making changes based on real time data. Recommendations to change in plan of care (POC) by the provider will be relayed by nursing via phone, and/or a patient portal message will be sent. Patient data later will be reviewed to support adherence with the diabetes regimen. This is achieved by nursing log into clinic account of CGM websites to spot check patients’ target readings. Nursing uploads CGM reports of the patients that fail to meet the predetermined threshold of 70% CGM target range to the patient’s charts. Nursing notifies provider through the patient portal. Provider reviews the data for trends and make any recommendations, if needed, to the POC and relay that information in writing to nursing. Nursing then will notify patients of changes, if any. Nursing will update patients’ med list if necessary. Nursing reassess the patient’s CGM readings in two weeks or as ordered by provider. Nursing gathers the following information: initial time in range, initial A1C, current time in range, and current A1C.

Since the start of this project in July 2020 to current date April 2021, a period of 9 months, our clinic’s average TiR had increased by 3.4 percentage points, the average A1C has decreased by 2.4. It is hypothesized with more time these results should improve to a point. This is a rolling enrollment so as more diabetic patients choose to use a CGM, the initial average should remain fairly consistent, as the current average may fluctuate with time vs. participants. Anecdotally, patients have voice their satisfaction about the follow up by nursing and medical team to their CSM reports. One of the patients stated they are always grateful for the call from “our favorite nurse.”