(1033) Continuous Glucose Monitoring in an Indigent Population with Historically Low Access to Technology

Objectives: The objective of this report was to review the effectiveness of continuous glucose monitoring (CGM) in indigent populations to facilitate the management of diabetes mellitus. Recommendations for self-management of diabetes include monitoring blood glucose daily to allow for therapeutic lifestyle and pharmacotherapy changes to reduce the occurrence of complications. Recent advancements in glucose monitoring technology have increased glucose data access for patients and prescribers. In both type 1 and type 2 diabetes mellitus, studies have demonstrated that CGM has reduced A1C over the traditional self-monitoring of blood glucose without changing insulin doses or medications. Current literature supports the use of CGM to improve glycemic control, however, these studies have failed to evaluate the impact on the use of CGM in indigent populations. CGM costs range from $100 to $300 per month for individuals who do not have insurance coverage. Low economic status is associated with worse diabetes mellitus outcomes, and evaluating the use of CGM in this population can provide guidance on how to better assist these patients.

Methods: This review focused on assessing the utilization and impact of intermittent and real-time CGM systems within an indigent population. The healthcare facility operates two clinics, which approved the use of 50 sensors and 20 readers at each location; It took approximately 8 months to enroll 100 patients. At the time of this review, approximately 50 patients had completed their initial A1Cs. Patients were provided CGMs if their A1C level was greater than 8%, had suspected hypoglycemia, hypoglycemia unawareness, procedure or surgery delay due to elevated glucose levels, or the presence of significant diabetic complications. The patients received two sensors every 28 days. If they did not have a compatible cell phone, they were provided with sensors and a reader. Patients were followed by a multidisciplinary team including clinical pharmacists, registered nurses and registered dietitians based on individual needs. Additionally, participants were scheduled to attend a carbohydrate counting class and obtain an A1C at 3-month intervals.

Results: Of the 50 patients included in the review, 52% were male and approximately 35% of patients used a reader. Overall, 86% of the individuals in this group were reported as Hispanic/Latino in ethnicity, 6% were Black, 4% were White, and 4% were Asian. Most patients were referred to the CGM program due to having an A1C greater than 8%, however, 10% was included due to type 1 diabetes mellitus (T1DM) or hypoglycemia. Approximately 16% of individuals were discontinued from the program due to self-discontinuation, pregnancy, insurance or poor adherence. Average A1Cs prior to initiating the CGM program were 9.86%, and approximately 3 months later, their A1C average was 7.77%. Of the 18 individuals who completed their 6-month A1C, the average decreased to 7.26%. In the patients suspected of having hypoglycemia, their initial A1c average was 8.38% and decreased to an average of 6.65% over the course of 3-6 months. Lastly, the sole T1DM patient initially had an A1C of 13.2% and after 6 months obtained an A1C of 8.5%.

Conclusions: This review showed that patients of lower socioeconomic status were able to decrease their A1Cs over the course of 3-6 months effectively. CGM provides self-awareness, supports lifestyle modifications and improves adherence. Prioritizing accessibility could mean improved glucose control, and subsequently, reduced diabetes related complications within indigent populations.