Addressing barriers to CGM prescriptions in primary care: a quality improvement initiative

The American Diabetes Association has declared continuous glucose monitoring (CGM) use to be the standard of care in patients with diabetes mellitus (DM) on insulin. While primary care providers (PCPs) manage most patients with DM, the adoption of CGMs in the primary care setting remains significantly lower than in endocrinology practices. PCPs have reported education, insurance authorisation and challenges of a PCP environment as significant barriers to CGM use. Our project sought to increase CGM prescriptions at our academic primary care clinic by creating tools to address these barriers.This is a single-centre quality improvement study at our academic primary care practice with the aim to increase CGM prescriptions in our patients with DM prescribed insulin, excluding patients seen by the endocrinology department. Three interventions were introduced over a 10-month period: (1) an educational pamphlet detailing insurance coverage, ordering and documentation requirements, (2) electronic health record tools to aid in ordering and documentation and (3) a didactic session focused on CGM data interpretation. The number of CGM prescriptions beginning August 2024 was reported monthly. Provider comfort with CGM prescription and data interpretation was assessed using a Likert scale of 1-5 (5 being the most comfortable).Following all three interventions, CGM prescriptions increased by 6.6%. On survey, providers reported improvements in correctly prescribing CGMs and comfort in interpreting CGM data. Referrals to endocrinology for type 2 DM also decreased by 25.3%.Despite known benefits of use in DM care, CGMs are underused in the primary care setting. Provider education and tools led to an increase in CGM prescriptions and improved PCP comfort with CGM use. These interventions demonstrate an effective way to address key barriers to CGM use in primary care.