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Oct 26, 2022
Continuous glucose monitoring (CGM) is associated with improved outcomes in type 1 diabetes. However, racial-ethnic differences remain in utilization. The researchers were interested in exploring whether addressing structural healthcare constraints will affect provider prescribing patterns to make CGM availability more egalitarian. From January 2019 to December 2021, they used multilevel stakeholder input to develop and implement several non-grant-funded practice transformations targeted toward equity, which included developing a type 1 diabetes clinic, conducting social needs assessments and management, training supporting staff to place trial CGMs at the point of care, optimizing prescription workflows, and educating providers on CGM. Transformations were prioritized based on practicality, acceptability, and sustainability. The researchers collected monthly aggregate data from the electronic medical record to assess the effect on prescribing practices. They did multiple linear regression to examine and compare changes in CGM prescriptions during the 3 years of transformation. In total, the researchers included 1,357 persons with type 1 diabetes in the analysis (mean ± SD age 38 ± 18 years; 30% Black [n=406], 45% Hispanic [n=612], 12% White [n=164]; and 74% publicly insured [n=1,004]). During the period of transformation, CGM prescription rates increased overall from 15% to 69% (P<0.001). Improvements were seen similarly among Black (12% to 72%), Hispanic (15% to 74%), and White individuals (20% to 48%) (between-group P=0.053). Diabetes practice changes that target equity, offload provider loads and focus on realistic, sustainable stakeholder-driven solutions can tremendously benefit provider prescribing practices to minimize core causes of inequity in CGM among underserved persons with type 1 diabetes. Continued focus is needed on upstream factors of downstream CGM use.
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