Utilization of Continuous Glucose Monitors in a Group Medical Visit Setting

Abstract

Aim: The aim of this study is to assess the utilization of CGMs in a GMV setting to improve patient activation and engagement, quality of life, and metabolic outcomes including glycemic control through modified lifestyle behaviors in patients with Type 2 diabetes. Background: Group medical visits (GMV) are an evidence-based care model shown to improve outcomes in diabetes. Monitoring tools that readily demonstrate cause-and-effect relationships between recommended lifestyle interventions and optimal glycemic control in the short and long term can be utilized to improve diabetes outcomes. Continuous glucose monitoring systems (CGMs) are wearable devices that continuously measure interstitial glucose and provide valuable feedback on glycemic changes in response to diet and exercise. With this data, patients are given nearly immediate feedback, empowering them to make dynamic behavioral changes. Methods: We implemented GMV for 16 adults from an academic community-based primary care clinic. Two separate cohorts consisting of 8 participants each, met for a total of 14 weeks with sessions every 2 weeks. Baseline HbA1c and lipid panels were collected within 3 months of the first GMV and at the end of the 14 weeks. Validated questionnaires (PAM-13 and SF-12) were collected at the initial and final GMV. Paired t-tests for these differences between the two times were also calculated. Significance was set at p < 0.05. Findings: At the end of the 14 weeks, participants had a significant reduction in HbA1c (0.4%; p < 0.05), weight (6.4 lbs; p < 0.05), and average glucose (calculated by CGM, 21.1 mg/dl; p < 0.05). 38.5% of participants decreased their HbA1c to the prediabetes range. There was no significant difference for lipids, PAM-13, or SF-12 or blood pressure. Participants reported subjectively that the CGM was helpful to see the relationship of foods and their glycemia.