Journal-based CME Course: Primary CareInitiated Continuous Glucose Monitoring in Adults With Insulin-Treated Diabetes

Activity ID

15137

Expires

September 17, 2029

Format Type

Journal-based

CME Credit

1

Fee

$30

CME Provider: JAMA Network Open

Description of CME Course

Importance  Most diabetes care is managed in primary care settings, which represent a critical yet underutilized site for continuous glucose monitoring (CGM) adoption. Whether CGM initiation by primary care clinicians improves glycemic outcomes and reduces acute health care utilization remains understudied.

Objective  To evaluate the association of primary care–initiated CGM with changes in hemoglobin A_1c (HbA_1c) levels and rates of hospitalizations and emergency department (ED) visits among adults with insulin-treated diabetes.

Design, Setting, and Participants  This cohort study was performed at 18 primary care clinics within Montefiore Medical Center, a large safety-net health system in the Bronx, New York. Adults 18 years or older with any insulin-treated diabetes who had at least 1 primary care visit between August 1, 2022, and August 1, 2025, were included. Patients were excluded if they were uninsured, if they had a CGM prescription in the prior 2 years, or if their first CGM during follow-up was prescribed outside primary care.

Exposure  First CGM prescription by a primary care clinician.

Main Outcomes and Measures  The primary outcomes were HbA_1c level trajectories, which were analyzed using mixed-effects models, and hospitalizations and ED visits, which were analyzed using recurrent event frailty models.

Results  The study included 8502 insulin-treated CGM-naive adult patients with diabetes (mean [SD] age, 62.3 [14.6] years; 4764 [56.0%] female; 3618 [42.6%] with Medicare and 2854 [33.6%] with Medicaid coverage). Of these, 2392 patients (28.1%) were prescribed CGM by primary care clinicians. Patients who initiated CGM were younger, more often English-speaking and commercially insured, and had higher baseline HbA_1c levels and more microvascular complications. At 12 months, HbA_1c levels decreased by 0.66 (95% CI, 0.57-0.75) percentage points (pp) in patients who initiated CGM vs 0.17 (95% CI, 0.08-0.27) pp in those who did not, with a between-group difference of −0.49 (95% CI −0.62 to −0.35) pp. CGM initiation was associated with lower risk of recurrent hospitalizations (hazard ratio, 0.87 [95% CI, 0.77-0.98]) and ED visits (hazard ratio, 0.82 [95% CI, 0.74-0.91]).

Conclusions and Relevance  In this cohort study of adults with insulin-treated diabetes, initiation of CGM by primary care clinicians was associated with clinically meaningful improvements in HbA_1c and significant reductions in recurrent hospitalizations and ED visits. These findings support expanding CGM implementation in primary care settings as a scalable strategy to improve diabetes outcomes and reduce acute care utilization, particularly in underserved populations.

Disclaimers

1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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