Primary care initiation of continuous glucose monitoring may be associated with greater reductions in hemoglobin A1c and acute care utilization among adult patients with insulin-treated diabetes.
In a cohort study across 18 primary care clinics between August 2022 and August 2025, researchers analyzed the outcomes of 8,502 adult patients receiving insulin therapy who had not previously used continuous glucose monitoring (CGM). Patients were excluded if they were uninsured, had received a CGM prescription during the previous 2 years, or first received the device from a specialty clinician rather than a primary care clinician.
The primary outcome was longitudinal change in hemoglobin A1c (HbA1c), and the key secondary outcomes were recurrent all-cause hospitalizations and emergency department visits. The researchers evaluated HbA1c trajectories with mixed-effects models and acute care utilization with recurrent event models while adjusting for demographic and clinical characteristics.
Overall, 2,392 patients initiated CGM through primary care. At 12 months, HbA1c decreased by 0.66 percentage points among the patients who initiated CGM vs. 0.17 percentage points among those who did not, representing a between-group difference of 0.49 percentage points. The improvement persisted through 24 months.
CGM initiation was also associated with a 13% and 18% lower likelihood of recurrent hospitalization and emergency department visits during follow-up, respectively. The patients whose diabetes care was managed exclusively in primary care experienced similar reductions in both glycemic measures and acute care utilization.
Prespecified subgroup analyses showed generally consistent glycemic benefits across age, sex, language, insurance, and race and ethnicity groups. The patients who had baseline HbA1c levels above 9% experienced larger reductions compared with those who had lower baseline values. The researchers also noted that just 28% of eligible patients received a CGM prescription during the study period despite insurance coverage and clinical eligibility.
The study had several limitations. Because it was observational, the findings demonstrated an association rather than causation. CGM exposure was defined by prescription rather than confirmed device use, unmeasured confounding may have remained despite statistical adjustment, acute care events outside the health system may not have been captured, and the findings may not be generalizable to uninsured patients or those without ongoing primary care.
The findings suggested that expanding CGM within primary care settings may improve diabetes management while reducing acute health care utilization.
"Future prospective studies are warranted to further clarify the optimal strategies for CGM implementation, clinician training, and patient education to maximize the long-term impact of CGM on clinical outcomes and health care utilization," wrote lead study author Jovan Milosavljevic, MD, of the Fleischer Institute for Diabetes and Metabolism in the Division of Endocrinology at the Montefiore Medical Center's Albert Einstein College of Medicine, and colleagues.
Full disclosures of the study authors can be found in the study.
Source: JAMA Network Open