A Pre-Post Assessment of Blood Glucose Control Following Pharmacist-Led Professional Continuous Glucose Monitoring in...

Professional continuous glucose monitoring (proCGM) can improve glycemic control and support medication and lifestyle adjustments in people with diabetes. In 2022, the Care Transformation Collaborative of Rhode Island launched a quality improvement initiative to implement pharmacist-led proCGM services in primary care practices. This project aimed to determine the effects of a pharmacist-led proCGM service on glycemic control, overall and by practice site, compared to baseline hemoglobin A1C (A1C) level. A secondary aim was to assess care team members' views of the program impact on patients and the practice environment.

A pre-post design was employed to assess reduction in A1C level 6 months following the implementation of pharmacist-led proCGM at six primary care sites. Pharmacists placed sensors, interpreted CGM data, and initiated diabetes medication changes. Eligible adult patients had either suboptimal glycemic control, discordant A1C and self-monitoring data, high hypoglycemia risk, or were referred by a provider. Changes in A1C were assessed 3-6 months after proCGM use. Care team surveys captured perceptions of the program's impact and sustainability.

Among 396 patients, mean A1C decreased from 9.36% to 8.25% (p < 0.0001). A ≥ 1% point A1C reduction was achieved in 45.2% of patients. In multivariable analysis, baseline A1C was the strongest predictor of A1C improvement. Patients not using insulin and those who adopted personal CGM after the intervention were also more likely to improve. The majority of 51 care team members who completed the survey strongly agreed the service had positive impacts on patients and staff, and a majority believed the service could be sustainable.

Pharmacist-led proCGM services were associated with meaningful short-term A1C reductions, especially in patients with high baseline A1C not using insulin. The model was well-received by care teams and may help expand access to effective diabetes management in primary care settings.