Professional continuous glucose monitoring and endocrinology eConsult for adults with type 2 diabetes in primary care: Results of a clinical pilot program

Abstract

Background Limitations in access to specialty diabetes care exist. Endocrinology eConsult that integrates professional continuous glucose monitoring (CGM-enhanced eConsult) may improve healthcare delivery, but has yet to be evaluated. We implemented a pilot program for patients with type 2 diabetes (T2DM) managed by primary care clinical pharmacists using CGM-enhanced eConsult and evaluated the acceptability and clinical outcomes in comparison to routine in-person endocrinology consultation. Methods Seventy-four adult patients with established T2DM (age 18–65) were included. Twenty-nine were seen in-person by endocrinology and 45 were seen by pharmacists in primary care. Thirteen patients were referred for CGM-enhanced eConsult. Acceptability was assessed with pre/post clinician acceptability questionnaires and patient assessment of perceived burden. Clinical outcomes included time to first specialty appointment, baseline and 3-month follow-up HbA1c, and antihyperglycemic medication use. Results There were no differences in patient acceptability of the CGM-enhanced eConsult as compared to endocrinology referral or pharmacy care. At baseline, all patients referred for eConsult were prescribed insulin. Three-month glycemic outcomes were comparable, with HbA1c reduction 1% + 2% in endocrinology, 1.5% + 1.1% with CGM-enhanced eConsult, and 1.6% + 1.8% in clinical pharmacy (p = 0.19). Time to an initial diabetes visit with a pharmacist was significantly shorter than with endocrinology, 20 days (IQR 26) for pharmacy vs. 45 days (IQR 54) for endocrinology, (p = 0.0001). Conclusions CGM-enhanced eConsult resulted in more timely access to endocrinology expertise, was acceptable to patients, and resulted in similar short-term glycemic outcomes compared to in-person consultation. Effectiveness of CGM-enhanced eConsults should be further explored.

Management of Medico-Legal Risks in Digital Health Era: A Scoping Review

“…Digital revolution is changing and will radically change the way healthcare is conceived (1). Currently, several artificial intelligence (AI) products have been developed, covering all aspects of healthcare, like the prediction of the risk of acute or chronic disease (e.g., cardiovascular risk, gastrointestinal bleeding, glaucoma), the prediction of risk of cancer/cancer recurrence and the survival likelihood in oncologic patients, the management of common chronic conditions (e.g., optimization of insulin dose in type-1 diabetes), the organization of clinical, surgical and anesthesiologic services, and the discovery of new drugs (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). AI can work and evolve only if personal health information is collected in datasets.…”

Professional continuous glucose monitoring in patients with diabetes mellitus: A systematic review and meta‐analysis

“…Specifically, one single study, an RCT, described a mixed type 1/type 2 diabetes cohort, 24 while the other two reported outcomes for each type of diabetes as separate cohorts 22,23 ; thus, 24 data sources were identified. Thirteen studies were conducted in patients with type 2 diabetes, 11,17,22,23,[25][26][27][28][29][30][31][32][33] seven of which were RCTs, four were observational retrospective studies, one was a nonrandomized prospective study, and one was a quasi-experimental prospective study. Ten studies were conducted in patients with type 1 diabetes, 22,23,[34][35][36][37][38][39][40][41] nine of which were RCTs and one was a retrospective study.…”

“…with the Cochrane Collaboration's tool for RCTs (Figures S4, S5) and the National Heart, Lung, and Blood Institute Quality Assessment Tool for observational studies. The quality of included observational studies (n = 5) was rated as fair, with risk of biases mostly concerning lack of sample size calculation, lack of blinding and, in two studies, 28,29 lack of adjustment for potential confounding factors. A sensitivity analysis including only RCTs with a reasonably low risk of bias was performed, confirming the favourable effect of p‐CGM on HbA1c change (−0.29%, 95% CI −0.42 to −0.16, P < 0.00001 [Figure S6]).…”

Pharmacist-Managed Diabetes Programs: Improving Treatment Adherence and Patient Outcomes

“…Endocrinologists reviewed the data and pharmacist documentation to develop a plan. 36 Another study looked at the integration of CGM into an established outpatient pharmacist managed diabetes program at the VA. Pharmacists at the VA had prescriptive authority to manage patients' diabetes regimens.…”