# Continuous Glucose Monitoring–Enhanced eConsult Improves Clinical Outcomes in Adults Living With Diabetes in a Safety Net Primary Care Setting

## TL;DR

Adding continuous glucose monitoring to electronic consultations improves diabetes care in a hospital setting by increasing access to specialist advice and modern treatments.

## Contribution

This study is the first to evaluate CGM-enhanced eConsults in routine diabetes care within a safety-net hospital.

## Key findings

- Endocrinologist recommendations were implemented in 86.6% of patients shortly after eConsults.
- CGM prescriptions increased 17-fold, and hypoglycemia levels decreased in monitored patients.
- Bolus insulin prescriptions increased by 56.3%, while sulfonylurea prescriptions decreased by 55.6%.

## Abstract

Background: There is a shortage of endocrinologists providing diabetes care. Electronic consultation (eConsult) improves access to subspecialty care, but the evaluation of CGM-enhanced eConsults in routine clinical practice has not been reported. We evaluated clinical outcomes after implementing a CGM-enhanced eConsult program in a safety-net hospital primary care clinic.

Methods: We completed a retrospective observational study assessing the clinical impact of the eConsult program. Participants included 67 adults (≥ 18 years) living with diabetes, receiving primary care at Boston Medical Center (mean age 65 years, 40.3% male, 79.1% Black, and 92.5% Type 2 diabetes). Demographic, clinical, and CGM data were analyzed from the medical record and Abbott's LibreView and Dexcom's Clarity web-based applications. Descriptive outcomes within 6 months post-eConsult included time to eConsult completion, hemoglobin A1c (HbA1c) change, medication adjustments, CGM prescription rates, and CGM-derived hypoglycemic metrics.

Results: Mean time to eConsult completion was 5.8 days. Endocrinologist recommendations were implemented in 86.6% of patients at the first primary care visit post-eConsult and in 94.0% of patients within 6 months. Within 6 months, HbA1c was unchanged (mean change 0.2% ± 0.4%). Relative to baseline, sulfonylurea prescription decreased 55.6%. The percentage of those prescribed basal insulin was unchanged, but basal insulin doses decreased in 41.8% of patients. Bolus insulin prescription increased 56.3% relative to baseline. Absolute CGM prescriptions increased from 2.9% at baseline to 49.3%. In 11 CGM users with sufficient CGM data for interpretation at 6 months, Level 1 hypoglycemia (54–69 mg/dL) decreased by 2% and Level 2 hypoglycemia (< 54 mg/dL) decreased by 0.7%.

Conclusion: In adults living with diabetes cared for in a safety-net hospital, CGM-enhanced eConsult provides timely access to endocrinologist expertise, recommendations are widely implemented by primary care clinicians, and guideline-directed modern diabetes therapeutic use increases, including a 17-fold increase in personal CGM prescriptions.