(1076) Pharmacist Impact on Continuous Glucose Monitoring Utilization in Family Medicine, Graduate Medical Education Clinics

Objectives: There are several commercially available continuous glucose monitors (CGMs): real-time, intermittently scanned, and professional CGMs. Routine use of these devices has shown positive reductions in hemoglobin A1c and hypoglycemic episodes. Recommendations by professional organizations around the use of CGMs have continued to evolve. The 2023 American Diabetes Association (ADA) Standard of Medical Care in Diabetes recommends the use of real-time or intermittently scanned CGMs in all patients with diabetes requiring multiple daily insulin injections, continuous insulin infusions, or basal insulin alone. Third party payers have responded to these guideline changes by removing barriers to authorization and improving access to CGM technology.

Despite evolving professional guidelines, expanding coverage, and growing body of evidence, CGM uptake has been variable depending on patient population and practice setting. This study will take place at two family medicine resident training sites, each with a full-time clinical pharmacist. Via a collaborative practice agreement (CPA) with overseeing medical residents and attendings, the pharmacists co-manage diabetes. When managing diabetes, the pharmacists noted underutilization of CGM technology. In a recent survey of medical residents, 70.5% of resident respondents reported being uncomfortable utilizing CGMs in diabetes treatment. Another survey of medical resident directors/associate directors showed 32% of medical resident programs surveyed were looking to expand training of digital technology, including CGMs, for diabetes care. These highlight the need to increase physician comfort with prescribing, interpreting, and educating patients on CGMs. Limited data exists describing outcomes between use of personal CGMs in primary care and pharmacist involvement in diabetes management.

The purpose of this study is to evaluate CGM prescribing habits and A1C outcomes for patients utilizing personal CGMs at two medical residency primary care clinics between January 1, 2021 - December 31, 2022. This study aims to: (1) evaluate the frequency and type of CGM prescribed in patients with diabetes mellitus at two medical residency clinics; (2) compare percentage of patients with hemoglobin A1C >9% before and after initiating CGM at 3, 6, 9, and 12 months; and (3) assess impact of hemoglobin A1C and medication changes with pharmacist involvement in management of patients with diabetes utilizing personal CGMs.

Methods: The study was approved as exempt by OhioHealth’s Institutional Review Board. A retrospective chart review will be performed at two resident-led, family medicine clinics within the aforementioned health system. Patients who are ≥ 18 years of age, have a documented diagnosis of either type 1 or type 2 diabetes, are prescribed a patient owned CGM, and seen by a physician at either practice site between January 1, 2021, and December 31, 2022, will be included in this chart review. Targeted sample size will include 250 unique charts. Patients can be on any diabetes regimen with varying levels of glycemic control. An electronic data collection form created in REDCap will be used by the principal investigators to capture data during the chart reviews. Descriptive statistics will be calculated.

Results: Research in progress.

Conclusions: The project will provide data on how pharmacists impact CGM prescribing habits and highlight the potential to provide more formal CGM education within medical resident clinics. Furthermore, the results of this project will add to the existing body of literature in support of incorporating pharmacists within family medicine resident clinics.