Expanding CGM Access
By Arvind Sommi
Access to continuous glucose monitors (CGM) can be severely limited. Tamara Oser, a researcher at the University of Colorado, launched PREPARE 4 CGM, a project to implement the devices into primary care practices in Colorado.
While endocrinologists are usually well-versed in CGM usage and the importance of TIR goals, 90% of people with type 2 diabetes and 50% of people with type 1 diabetes are treated at primary care practices, and many primary care providers may not be familiar with CGMs. The PREPARE 4 CGM initiative seeks to address this problem by piloting strategies to implement CGMs in various primary care practices in Colorado.
Why CGMs Belong in Primary Care Practices
“CGM is probably coming for everybody with diabetes,” said Tamara Oser, director of the Primary Care Diabetes Lab at the University of Colorado and research leader for PREPARE 4 CGM. Her goal is to reach beyond academic medical centers and endocrinologists and into primary care settings, where most people receive their diabetes care.
“Your access to diabetes technologies that are evidence-based shouldn’t be determined by your zip code or social determinants of health,” she said.
Once a primary care practice is enrolled in the PREPARE 4 CGM study, it is assigned to one of two groups. In one, family medicine doctors are provided with a self-guided toolkit with training modules to prepare them for CGM initiation and management. Topics include patient selection, shared decision-making, and how they can get reimbursed for prescribing CGM. In the other group, doctors will receive the CGM toolkit and a facilitator to help the medical team implement CGM technology and ensure its sustainability.
Insurance Coverage and Language Hurdles: The Biggest Barriers to CGM Access
One of the most significant barriers to CGM access is navigating insurance. Oser suggested that one solution is to start with professional CGM, which is more frequently covered by insurance plans, so that people with diabetes can be better engaged with their blood glucose levels while the provider works with insurers to meet coverage requirements. The toolkit included in PREPARE 4 CGM contains resources on how providers can navigate various insurance systems.
While Oser’s initiative includes primary care practices in rural areas and regions with Spanish-speaking populations, she encourages providers not to think of language as a barrier.
“We as providers have a lot of implicit bias, but when we go into thinking about a population as a whole having barriers to CGM, that is really dangerous,” she said. (While Oser does not speak Spanish herself, with the help of an interpreter, she has successfully onboarded many Spanish-speaking people with diabetes.)
Rather than generalize about certain populations, Oser recommends healthcare providers problem-solve at an individual level. She emphasizes that people with diabetes should be mindful about advocating for themselves by not letting their providers make assumptions about them and switching providers if someone else can provide better help.
PREPARE 4 CGM: Early Results and Expansion Plans
Initial response to the initiative has been overwhelmingly positive. “We have never, in the history of the department, had a project that recruited this fast,” Oser said, noting that while most primary care providers are now aware of CGMs, partly because of the many advertisements, only about 38% are currently prescribing them. She hopes to expand PREPARE 4 CGM nationally and recruit practices from other states.
“As we continue to educate primary care, we are going to see those numbers go up,” she added, emphasizing how specific metrics such as TIR have helped her patients, “Time in range is so much more actionable and relevant for people with diabetes and their providers. Even if your overall time in range wasn’t within target, you still have some bright spots on your ambulatory glucose profile.”
PREPARE 4 CGM is open to primary care medical practices in the Colorado area. If you live in Colorado, please consider sharing this information with your primary care physician.
To learn more about access to continuous glucose monitors and time in range: