Title : Continuous glucose monitors impact on glycemic control among American Indian and Alaskan Natives: Single center, pre- post- comparison
Introduction: Continuous glucose monitors (CGM) technology provides insight into a complete picture of a person’s blood glucose levels throughout the day and the full effect insulin has on the blood glucose trends. The data generated by CGM can be used to make real-time therapeutic adjustments and facilitate improved patient outcomes.
Objective: To assess how professional CGM assisted pharmacists in clinical decisions making and how CGM helped American Indian and Alaskan Native (AI/AN) patients with insulin-treated Type 2 Diabetes Mellitus achieve targeted A1C control in an outpatient pharmacy-based clinic.
Practice Description: Intensive Diabetes Management Services (IDMS) is a clinic run by pharmacists within an outpatient health center that provides comprehensive diabetes services under a collaborative practice agreement that includes prescriptive authority, ordering labs, and referrals. Indian Health Service setting provides pharmacists the opportunity to use their medication expertise to its fullest capacity. Pharmacists utilize CGM technology to provide detailed data on the glucose trends over a wider time range vs finger stick blood sugar to optimize patient medication therapy. Pharmacists who are involved in IDMS have an opportunity to integrate CGM as part of their clinical decision-making.
Methods: This study involved retrospective chart review from June 2017 through February 2019. Inclusion criteria: Patients greater than 18 years old with uncontrolled insulin-treated type 2 Diabetes Mellitus enrolled in IDMS and prescribed CGM for 14 to 28 days of use. Exclusion Criteria: Patients with missing A1C results, failure to attend appointments, an allergy to adhesives, pregnancy, repeated monitor adhesive failure, or CGM data collection less than 72 hours. The primary outcome measure was a change from baseline in A1C after 3 months. A t-test was used to compare the differences between the two means.
Results: Initial data collection identified 71 AI/AN patients met initial inclusion criteria. Following chart review, 21 patients were excluded due to CGM adhesive failure, failure to attend appointments and missing initial or follow-up A1C. The remaining 50 patients were used for Dependent T-Test. The results from the pre-test (M = 9.58, SD = 1.38) and post-test (M = 8.42, SD = 1.11) indicate that CGM use resulted in an improvement of A1C, t(49) = 6.06, p = 1.87 x 10-7. There was a significant reduction in A1C following CGM utilization compared to patient data at baseline. Average A1C reduction was [1.2%] yielding average A1C change from [9.6%] at baseline to [8.4%] at study conclusion.
Conclusion: Results demonstrated that CGM was an effective tool in improving blood glucose levels and lowering A1C. Furthermore, it provided the ability for pharmacists to individualize medication treatment plans to patients with the correct dose of insulin promptly and facilitate discharge from the clinic due to patients reaching target A1C faster than patients not using CGM. Even though the study examined limited patients (n=71) from a specialized clinic, CGM proved to be a useful tool in identifying hypoglycemia and optimizing therapeutic decisions for hyperglycemia.