PCPs farther away from endocrinologists more often prescribe continuous glucose monitoring

Primary care physicians who practice farther away from endocrinologists were more likely to have prescribed continuous glucose monitoring for patients with diabetes, a study found.

Endocrinologists have established continuous glucose monitoring (CGM) as an important treatment option for patients with diabetes, but Tamara K. Oser, MD, an associate professor in the department of family medicine at the University of Colorado, and colleagues wrote in Annals of Family Medicine that “most patients with diabetes do not receive their diabetes care from an endocrinologist.”

“This is consequential for the approximately 90% of U.S. patients whose diabetes is managed in primary care settings,” they wrote. “If there is a disparity in CGM use between endocrinology and primary care practices, this would represent a substantial disparity in access to diabetes treatment and management.”

To analyze CGM uptake in primary care, the researchers developed a web-based survey with questions that examined:

• CGM awareness and prescriptions;
• factors relating to past and future CGM prescriptions;
• confidence in using CGM to address type 1 and 2 diabetes; and
• current resources supporting CGM use.

The analysis included 656 responses from PCPs and advanced clinicians.

Oser and colleagues found that 46.6% (n = 293) of respondents had seen a patient with CGM, but never prescribed CGM. Only 38.6% (n =243) had ever prescribed CGM, though 89.5% were somewhat likely to prescribe it in the future.

Physicians who were practicing more than 40 miles (n = 102) from the nearest endocrinologist were twice as likely to have prescribed CGM than physicians within 10 miles (n = 405) of an endocrinologist (OR = 1.94; 95% CI, 1.17-3.21), a trend that “aligns with the integrated, whole-person care approach intrinsic to primary care,” Oser and colleagues wrote.

Past CGM prescriptions “significantly predicated” greater confidence in using CGM to treat type 1 and 2 diabetes, the researchers noted, and this resulted in a greater likelihood of future prescriptions compared with clinicians who did not have prior experience.

“This suggests that once primary care physicians and advanced practice clinicians overcome the challenge of learning to prescribe and use CGM to manage diabetes, they are likely to continue doing it,” they wrote.

The study highlighted resources that could influence future CGM usage, as respondents said they would be moderately or very likely to prescribe CGM in the future with:

• CGM education training or workshops (72.3%);
• a consultation on insurance issues (72%);
• a one-time consultation with an endocrinologist (63.1%); or
• a virtual specialty care center to refer patients for direct support (63%).

Because of the study methods, no causation could be determined, Oser and colleagues noted. In addition, the study did not assess barriers to prescribing CGM. Also, because the survey was designed to better understand CGM-related factors, “respondents may have had greater interest in CGM than non-respondents, potentially introducing nonresponse bias,” the researchers pointed out.

Oser and colleagues concluded that patients with diabetes would benefit from more CGM prescriptions in a primary care setting, and that the findings suggest physicians are open to CGM treatment. However, “they need resources and support.”

“Expanded use can be supported with education targeted to residents, recent graduates, and practices without a nearby endocrinologist,” the researchers wrote.

Future research, they added, should focus on additional resources as well as clinician barriers and facilitators of CGM treatment.