The clinical utility of professional continuous glucose monitoring by pharmacists for patients with type 2 diabetes.

BACKGROUND

There are limited data regarding the use of diabetes technologies, such as professional continuous glucose monitoring (CGM), as part of a pharmacist-managed diabetes service.

OBJECTIVE

To assess how professional CGM affected treatment decisions and glucose control as part of a pharmacist-managed service for patients with type 2 diabetes.

PRACTICE DESCRIPTION

Clinical Pharmacy Specialists (CPS's) within an outpatient diabetes management service provide comprehensive diabetes care under a scope of practice that includes prescriptive privileges.

PRACTICE INNOVATION

Insight into glucose patterns is paramount for pharmacists to use their medication expertise to its fullest capacity. CGM technology can provide detailed data on glucose trends, including percentage of time spent in a target range. Pharmacists involved in the provision of diabetes care have the opportunity to integrate professional CGM into their practice to acquire data for targeted therapeutic adjustments.

EVALUATION METHODS

A retrospective analysis was conducted of patients with type 2 diabetes who had professional CGM used as part of their routine diabetes care with the CPS from 2017-2019. The primary outcome was the percentage of patients meeting their individualized A1c goal at baseline versus 6 months post placement of the professional CGM. A McNemar's test was used to compare the percentage of patients achieving A1c goal pre and postintervention. A P value of <0.05 denoted the presence of a statistically significant difference.

RESULTS

Patients who implemented professional CGM had an average duration of diabetes of 15.6 years and an average A1c of 9.1%. The majority (76.7%) were not meeting their individualized A1c goal. Hypoglycemia was identified in 57% of the patients; almost half of patients evaluated had periods of nocturnal hypoglycemia. Hyperglycemia was present on the vast majority of reports (83%) with postprandial elevations being the most common trend identified overall. Mean A1c decreased from 9.11% ± 1.4 at baseline to 8.64% ± 1.3 at 3 months and 8.19% ± 0.8 at 6 months. Compared with baseline, more than 2 times the number of patients were within their A1c goal range at 3 and 6 months (23.3%, 53.6% and 69.6% respectively.) This represented a statistically significant difference at both time points (P = 0.008 at 3 months and P = 0.006 at 6 months.) CONCLUSION: The use of CGM technology may overcome treatment barriers, such as insufficient self-monitoring of blood glucose and lack of discernment of glucose trends with traditional A1c testing. Pharmacists employing professional CGM as part of a diabetes management service were able to achieve targets for significantly more patients with type 2 diabetes on a wide range of treatment regimens at 6 months compared with baseline. Widespread use of professional CGM in pharmacist-managed diabetes services may provide valuable care and improve outcomes more broadly. Larger randomized trials are warranted to examine ideal patient selection and optimal frequency of use.