Simple Ways to Implement CGM into Your Practice
The vast majority of adults living with type 2 diabetes are managed in primary care, and patient interest in continuous glucose monitoring (CGM) is increasing. As CGM is now recognized as the standard of care for all patients with diabetes taking multiple daily injections of insulin and recommended for those taking basal insulin only,1,2 its widespread use in clinical practice is soon on the horizon.
The value of simply adding CGM to an individual's diabetes management toolbox is demonstrated in numerous clinical studies, evidenced by increases in time in range (TIR),3,4 reductions in hypoglycemia,5 and sustainable improvements in A1C.6 CGM is also recognized as a significant tool in the primary care setting for advancing therapy adjustments in patients living with diabetes.7
In a recent episode on the Real-Time, Real Talk podcast, Scott Urquhart, PA-C at Diabetes and Thyroid Associates in Fredericksburg, Virginia, breaks down the steps to implement CGM into practice simply and efficiently. He states that after gaining an understanding of the functionality of the product, establishing a workflow is key. In doing this, office staff who will access the CGM data (and upload to the electronic medical record, if preferred), interpret the data, and schedule the patient for follow up is identified.
Recognizing the natural learning curve in starting something new, with a clear workflow and practice with interpreting the Ambulatory Glucose Profile (AGP) report, visits become streamlined, leaving more time for meaningful dialogue with the patient. Once you get started, Urquhart reports it's difficult to practice efficiently without it.
He recommends starting slow with two to three CGM report interpretations per week and knowing your resources. There are virtual options to learn about CGM and other online resources to become familiar with both personal and professional CGM systems, interpreting the AGP report, and associated billing codes.
Listen to the Podcast HERE
- 1. ElSayed N, Aleppo G, et al; on behalf of the American Diabetes Association, 7. Diabetes Technology: Standards of Care in Diabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S111–S127. https://doi.org/10.2337/dc23-S007
- 2. Blonde L, Umpierrez GE, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract. 2022 Oct;28(10):923-1049. doi: 10.1016/j.eprac.2022.08.002. Epub 2022 Aug 11. Erratum in: Endocr Pract. 2023 Jan;29(1):80-81. PMID: 35963508.
- 3. Beck RW, Riddlesworth T, et al; DIAMOND Study Group. Effect of Continuous Glucose Monitoring on Glycemic Control in Adults With Type 1 Diabetes Using Insulin Injections: The DIAMOND Randomized Clinical Trial. JAMA. 2017 Jan 24;317(4):371-378. doi: 10.1001/jama.2016.19975. PMID: 28118453.
- 4. Beck RW, Riddlesworth TD, et al; DIAMOND Study Group. Continuous Glucose Monitoring Versus Usual Care in Patients With Type 2 Diabetes Receiving Multiple Daily Insulin Injections: A Randomized Trial. Ann Intern Med. 2017 Sep 19;167(6):365-374. doi: 10.7326/M16-2855. Epub 2017 Aug 22. PMID: 28828487.
- 5.Pratley RE, Kanapka LG, et al. Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020;323(23):2397–2406.
- 6. Šoupal J, Petruželková L, et al; Glycemic Outcomes in Adults With T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow-Up From the COMISAIR Study. Diabetes Care 1 January 2020;43 (1): 37–43.
- 7. Martens TW, Parkin CG. How use of continuous glucose monitoring can address therapeutic inertia in primary care, Postgraduate Medicine, 2022;134:6, 576-588, DOI: 10.1080/00325481.2022.2080419