PRP036: Barriers and Facilitators to Continuous Glucose Monitoring for Diabetes in Primary Care

Tamara Oser, MD; Sean Oser, MD, MPH; Tristen Hall, MPH; Elisabeth Callen, PhD; Brian Manning, MPH; Lyle Fagnan, MD; Donald Nease, MD; LeAnn Michaels; Jennifer Carroll, MD, MPH


Context: Glucose sensors, often called “Continuous Glucose Monitors” or “CGMs,” provide people with numeric and visual readings of their glucose levels to help them manage their diabetes. Continuous glucose monitoring is associated with improved outcomes for people with diabetes, but there is a significant disparity in access to clinicians with CGM training. Most individuals receive their diabetes care from primary care clinicians, yet PCPs get little or no training in CGM use, in contrast to endocrinologists. Access to CGMs may be limited by a general shortage of endocrinologists, CGM insurance coverage and reimbursement issues, and for many patients, lack of proximity to a nearby endocrinologist. Education to primary care clinicians about CGM holds promise for expanding access to CGM and improving diabetes care. Objective: 1) Explore barriers and facilitators to PCPs’ use of CGM for patients with diabetes, 2) develop strategies to expand awareness and training for CGM more widely in primary care. Study Design: Cross-sectional survey with cluster sampling through practice-based research networks [American Academy of Family Physicians (AAFP) National Research Network (NRN) and Oregon Rural Practice-based Research Network’s (ORPRN) Meta-network Learning and Research Center (Meta-LARC)] to achieve maximum variation in clinician years of practice, clinical role, and organization type; part of a larger explanatory sequential mixed methods study. Setting: Varied primary care practice settings (i.e. academic, health system, private) across the United States. Population studied: Primary care clinicians (physicians and advanced practice providers) (n≈500). Instrument: Web-based survey; invitations distributed via email. Outcome Measures: Primary care clinicians’ perceptions and experience related to CGM and providing care for patients with diabetes. Results: This presentation will describe primary care clinicians’ likelihood to prescribe CGM, confidence performing patient care related to CGM, perceptions of how various resources might influence their likelihood to prescribe CGM, referral patterns for patients with diabetes, challenges related to referring patients with diabetes to endocrinology, and perceived benefits of patients receiving diabetes-related care in primary care practices.
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Wilson Pace 11/21/2020

Hi folks- not sure I am tracking on this project entirely. Most people with type 1 are followed by endocrinology. Most people with type 2 don't need to do ANY glucose monitoring. Where exactly do you see this technology fitting in primary care? See Katrina Donahue's poster on predicting inappropriate use of glucose monitoring in primary care in the completed research area.

Tamara Oser

Thanks for your comment, Wilson! Many adults with type 1 and intensive insulin requiring type 2 diabetes receive their diabetes care from primary care clinicians/physicians. CGM in these populations has been included in ADA Standards of Medical Care. For those people with type 2 diabetes not on insulin, there is growing evidence surrounding the role of CGM in empowering patients to make behavioral changes. The relationships primary care clinicians have with their patients combined with use of CGM may represent an ideal setting to empower patients to make behavioral changes that can improve their A1c, diabetes distress, etc. 

Jen Carroll

Great job on this poster, Tamara, Sean, and team! Wilson's comment and questions raise some important issues that we have also learned about from the surveys and interviews. Namely-family physicians are all across the spectrum in terms of their level of enthusiasm and perceptions of value of  this technology. Further, there are likely ways we need to think about re: how to communicate these results in the context of currently recommended guidelines. It may be helpful as we prepare the results for further dissemination, to address the issues you mention in your reply. Again, great work on this!

Tamara Oser

Thanks Jen! Appreciate your comment and your tremendous contributions to this work. Agree that these are all important to consider in the context of dissemination. 

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