1015-P: Impact of Social Vulnerability on Resources for CGM Initiation across Michigan Primary Care Practices

Abstract

Objective: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan. MCT2D aims to improve type 2 diabetes care by encouraging prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diets. The study’s purpose was to describe clinic-level resources and barriers to CGM initiation in counties with high and low social vulnerabilities. Methods: We surveyed primary care practice providers about practice-level CGM patient education and barriers, and providers’ understanding of insurance coverage. 169 of 264 practices (64%) completed the survey. We classified practices as high vulnerability (HV; quartile 4), or low vulnerability (LV; quartiles 1-3) using the county-level CDC Social Vulnerability Index. Results: Among HV practices, the main CGM education was prescriber instruction (61.5%), while for LV it was printed material (69.8%). For both HV and LV practices the second most common educational resource was web links (53.9% and 51.6%, respectively). For both practice types, the most common barrier to CGM was patients’ lack of smartphone (60.5%, 62.4%, respectively), followed by patients’ lack of internet (55.3%) for HV practices and patients’ ability to use CGM (38.5%) for LV practices. Provider understanding of Michigan Medicaid CGM coverage policy was similar across practices with most reporting incorrectly that it was akin to Medicare (≥3 injections daily) (35.3% (HV) and 44.0% (LV)) or reporting lack of awareness of coverage (32.4% (HV) and 24.1% (LV)). Conclusions: There is a mismatch between practices’ educational approaches and patients’ access to technology. Improved transparency of CGM coverage criteria would enhance provider understanding and promote equitable access for patients. Limitations include that the data is county-level and further analysis evaluating other practice level social determinants of health is needed. Disclosure K.L.Khosrovaneh: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter & Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. C.D.Jamison: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. H.L.Diez: None. J.E.Aikens: None. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck & Co., Inc., Procter & Gamble, Johnson & Johnson, Eli Lilly and Company. J.Rau: None. J.Reiss: None. L.A.Young: None. J.Weisensel: None. P.Okeke: None. K.R.Mizokami-stout: None.