A study to assess initiation of CGM outside of a clinic
Gal R, Cohen N, Kruger D, Beck R, Bergenstal R, Calhoun P, Cushman T, Hoffmann A, Hood K, Johnson M, McArthur T, Olson B, Weinstock R, and Aleppo G. A study to assess initiation of CGM outside of a clinic. Diabetes Technology and Therapeutics 2020; 22:A-40.
Diabetes Technology and Therapeutics
Background and Aims: Our study assessed the feasibility of remotely initiating continuous glucose monitoring (CGM) at home outside of the clinic, as a means to expand CGM access. Methods: 35 adults 19-80 years old (mean HbA1c 8.5%) with T1D (N = 28) or T2D (N = 7) using basal-bolus insulin (7 pump, 28 MDI) with no CGM use within 24 months of enrollment were assigned a certified diabetes educator to provide remote CGM training via videoconference and/or phone. Participants selected either the Dexcom G6 or Abbott Free Style Libre and were followed for 12 weeks to assess adherence to CGM use and glycemic control. Results: One participant withdrew immediately after CGM initiation training. The remaining 34 were using CGM at 12 weeks; median CGM usage in the final 4 weeks was 7.0 days/ week (interquartile range 6.7 to 7.0). One additional participant did not have an HbA1c at 12 weeks. Mean HbA1c reduction from baseline to 12 weeks was 1.1% (P < 0.001). Mean time in range (70-180mg/dL) was 59% over the 12 weeks compared with baseline time in range estimated from HbA1c of 48%. Over 12 weeks, median time <70mg/dL was 1.4% and <54mg/dL was 0.2%. Surveys indicated substantial benefit of CGM with reduced diabetes distress, increased satisfaction with glucose monitoring and fewer perceived technology barriers to management. Conclusions: Remote CGM initiation and training was successful in achieving sustained CGM use and improved glycemic control after 12 weeks. If widely implemented, this approach could substantially increase the adoption of CGM by people with diabetes using insulin.