Siskind Samantha M, Dymek Ryanne, Fantasia Kathryn L, O'Brien Katelyn, Steenkamp Devin W
Section of Endocrinology, Diabetes, Nutrition & Weight Management, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
J Diabetes Res. 2025 Aug 5;2025:5547910. doi: 10.1155/jdr/5547910. eCollection 2025.
There is a shortage of endocrinologists providing diabetes care. Electronic consultation (eConsult) improves access to subspecialty care, but the evaluation of CGM-enhanced eConsults in routine clinical practice has not been reported. We evaluated clinical outcomes after implementing a CGM-enhanced eConsult program in a safety-net hospital primary care clinic. We completed a retrospective observational study assessing the clinical impact of the eConsult program. Participants included 67 adults (≥ 18 years) living with diabetes, receiving primary care at Boston Medical Center (mean age 65 years, 40.3% male, 79.1% Black, and 92.5% Type 2 diabetes). Demographic, clinical, and CGM data were analyzed from the medical record and Abbott's LibreView and Dexcom's Clarity web-based applications. Descriptive outcomes within 6 months post-eConsult included time to eConsult completion, hemoglobin A1c (HbA1c) change, medication adjustments, CGM prescription rates, and CGM-derived hypoglycemic metrics. Mean time to eConsult completion was 5.8 days. Endocrinologist recommendations were implemented in 86.6% of patients at the first primary care visit post-eConsult and in 94.0% of patients within 6 months. Within 6 months, HbA1c was unchanged (mean change 0.2% ± 0.4%). Relative to baseline, sulfonylurea prescription decreased 55.6%. The percentage of those prescribed basal insulin was unchanged, but basal insulin doses decreased in 41.8% of patients. Bolus insulin prescription increased 56.3% relative to baseline. Absolute CGM prescriptions increased from 2.9% at baseline to 49.3%. In 11 CGM users with sufficient CGM data for interpretation at 6 months, Level 1 hypoglycemia (54-69 mg/dL) decreased by 2% and Level 2 hypoglycemia (< 54 mg/dL) decreased by 0.7%. In adults living with diabetes cared for in a safety-net hospital, CGM-enhanced eConsult provides timely access to endocrinologist expertise, recommendations are widely implemented by primary care clinicians, and guideline-directed modern diabetes therapeutic use increases, including a 17-fold increase in personal CGM prescriptions.
提供糖尿病护理的内分泌专家短缺。电子会诊（eConsult）改善了专科护理的可及性，但在常规临床实践中对持续葡萄糖监测（CGM）增强型电子会诊的评估尚未见报道。我们在一家安全网医院的初级保健诊所实施了CGM增强型电子会诊项目后，对临床结果进行了评估。我们完成了一项回顾性观察研究，评估电子会诊项目的临床影响。参与者包括67名患有糖尿病的成年人（≥18岁），他们在波士顿医疗中心接受初级保健（平均年龄65岁，40.3%为男性，79.1%为黑人，92.5%为2型糖尿病）。从病历以及雅培的LibreView和德康的Clarity基于网络的应用程序中分析人口统计学、临床和CGM数据。电子会诊后6个月内的描述性结果包括电子会诊完成时间、糖化血红蛋白（HbA1c）变化、药物调整、CGM处方率以及CGM得出的低血糖指标。电子会诊的平均完成时间为5.8天。内分泌专家的建议在电子会诊后的首次初级保健就诊时有86.6%的患者得以实施，在6个月内有94.0%的患者得以实施。在6个月内，HbA1c没有变化（平均变化0.2%±0.4%）。相对于基线，磺脲类药物处方减少了55.6%。基础胰岛素处方的患者比例没有变化，但41.8%的患者基础胰岛素剂量减少。推注胰岛素处方相对于基线增加了56.3%。绝对CGM处方从基线时的2.9%增加到49.3%。在11名在6个月时有足够CGM数据可供解读的CGM使用者中，1级低血糖（54 - 69毫克/分升）下降了2%，2级低血糖（<54毫克/分升）下降了0.7%。在一家安全网医院接受护理的糖尿病成年患者中，CGM增强型电子会诊提供了及时获得内分泌专家专业知识的途径，初级保健临床医生广泛实施了相关建议，并且指南指导的现代糖尿病治疗应用增加，包括个人CGM处方增加了17倍。
