(1340) Evaluation of Diabetes Outcomes Through Pharmacist-assisted Interventions Using Personal Continuous Glucose Monitors in a Primary Care Clinic

Objectives: Effective glycemic control is crucial for managing diabetes and reducing the risk of long and short-term complications. Personal Continuous Glucose Monitors (CGMs) offer a way of continuously tracking glucose while minimizing the need for fingerstick testing. With enhanced insurance coverage, the use of personal CGMs is increasing, but their successful implementation requires appropriate initial education and placement; ongoing disease management using CGM reports; and continued support for troubleshooting and adherence. A small pool of evidence supports utilizing pharmacists to provide CGM-related interventions using professional CGMs in specialty care settings; however, the impact of pharmacist-assisted interventions on diabetes outcomes in patients using personal CGMs in primary care settings remains to be systematically evaluated.

The objective of this study is to assess the impact of pharmacist-assisted interventions in adult patients with diabetes using personal CGMs in a primary care clinic.

Methods: This IRB-approved study was a single-center retrospective chart review ofadult patients with diabetes who received pharmacist-assisted interventions utilizing personal CGMs at a primary clinic between May 2021 and May 2023. Eligible participants consisted of patients diagnosed with Type 1 or Type 2 diabetes who were indicated and referred to a pharmacist for diabetes management using a personal CGM and attended at least one pharmacist visit. Patients with no HbA1c value at 6±3 months were excluded. Personal CGM devices used by patients in this clinic included: Dexcom G6, Dexcom G7, FreeStyle Libre 14-day, Freestyle Libre 2, and Freestyle Libre 3. Pharmacist-assisted interventions included personal CGM placement and initial education visit, CGM interpretation and disease management visits, or both. Patients’ demographic information, ambulatory glucose profile (AGP) from visits with the pharmacist, diabetes-related laboratory data, and medication and disease-related interventions from each visit with pharmacist per the electronic health record were collected. The primary endpoint was a change in HbA1c at 6±3 months. Secondary endpoints included change in HbA1c at 12±3 months, achievement of A1c goal, number of medication and disease-related interventions, number of hypoglycemic events or related emergency room visits or hospitalizations, and achievement of AGP goals. Statistical analysis of the primary outcome was conducted using IBM® SPSS version 29. Wilcoxon-signed rank test was used to analyze the primary endpoints with p-value of < 0.05 being statistically significant. Baseline characteristics were analyzed using descriptive statistics.

Results: A total of 29 patients were included in the final analysis: 50% female, median age of 59.5 years, 72% Caucasian, and 94% diagnosed with Type 2 Diabetes with a median HbA1c of 9.0%. The majority of patients were seen for both an initial placement education visit and ongoing management visits (63%, n=20). There was a statistically significant reduction in HbA1c from baseline (9.0%) to 6±3 months (7.3%), a difference of -1.7% (p < 0.001). Analysis of secondary endpoints is pending.

Conclusions: Pharmacist-assisted interventions using personal CGMs in a primary care setting results in a statistically and clinically significant HbA1c reduction at 6±3 months. Replicating this study at other primary care clinics with pharmacist involvement may fill the void of evidence that supports pharmacist FTE and resources in order to implement personal CGM workflow and to improve diabetes outcomes.