Clinical Outcomes Associated with Referral-Based Continuous Glucose Monitoring Using a Central Standardized Interpretation Strategy

Abstract

Continuous glucose monitoring (CGM) devices can present a challenge to health providers given the sheer amount of data collected. A referral-based system using a centralized standard interpretation completed by a specialist could highlight the most pertinent information and provide recommendations. Professional (retrospective) CGM reports from an outpatient academic endocrinology clinic were formally interpreted by one of two specialists. General recommendations for therapy adjustments were made to each patient's referring provider without a face-to-face visit using only the CGM download and patient logs. Findings were characterized as well as change in hemoglobin A1c (HbA1c) by 6 and 12 months. Patients with baseline HbA1c values above 8.1% experienced a significant reduction (-0.36 ± 0.80%) at 6 months post-CGM (P = 0.035), whereas those with baseline HbA1c below 8.1% experienced an equally significant increase (0.36 ± 0.83%, P = 0.032), most likely because of interventions that addressed hypoglycemia. Hypoglycemia was common, and unrecognized overnight hypoglycemia lasting over 2 h occurred in 48% of patients. There were no differences in findings or in HbA1c changes among pump compared with non-pump users. In total, 69% of patients had a change in management by the referring provider within 1 month. The data suggest that some patients benefited, in the form of reductions in HbA1c, from centralized referral and interpretation of professional CGM regardless of modality of insulin therapy. Considerations for methods to improve coordination with referring providers for follow-up care are needed.