Since continuous glucose monitors (CGMs) first became commercially available in 2000, numerous studies have shown that their use improves the management of diabetes for both pediatric and adult patients and both type 1 and type 2 diabetes. 1-5 However, there remain little data on their efficacy in certain subpopulations such as patients with significant medical comorbidities, mental health conditions, or substantial social barriers, who were largely excluded from the studies of CGM's efficacy. 6 Commonwealth Care Alliance (CCA) is a not-for-profit, community-based healthcare organization that offers comprehensive health plans to patients dually eligible for Medicare and Medicaid, a medically and socially complex patient population. In April 2017, CCA launched a pilot program to implement professional CGMs in patients with diabetes who had poorly controlled hyperglycemia or suspicion of asymptomatic hypoglycemia. The device used in this pilot was the Freestyle Libre Pro System, a professional CGM that does not provide patients with real-time access to glucose readings. Patients continued their prior methods of glucose monitoring and control while using the device. The CGM was placed for a minimum of one week (range: 8-18 days). The data collected were reviewed by CCA clinicians and used to guide clinical decision making. Surveys were conducted with the patients and clinicians to determine the user and provider experience with the device. Thirteen patients were enrolled in the study (Table 1). The cohort had a high burden of chronic disease (average of 14.5 chronic conditions), behavioral health conditions (100% carried a mental health diagnosis), functional needs (100% required assistance with activities of daily living or instrumental activities of daily living), and recent hospitalizations (62% were hospitalized in the last year). The average pre-CGM hemoglobin A1c (HbA1c) was 9.4% with a range of 6.2% to 14.5%. The average change in HbA1c was −0.5% (P = .38). Among the nine subjects with starting HbA1c values above 8% (enrolled for uncontrolled hyperglycemia), the average HbA1c change was −0.9% (P = .23).
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