Continuous Glucose Monitoring: Facilitating the Initiation and Use for Patients with Type2 Diabetes Mellitus in a Rural Primary Clinic

Background: Type 2 diabetes mellitus continues to be one of the most significant health problems worldwide. It can lead to several health complications, such as amputations, vision loss, neuropathy, kidney disease, and cardiovascular disease. These complications can be delayed or even avoided by maintaining glycemic stability through effective self- and medical management. Continuous glucose monitors (CGM) help both patients and providers manage glycemic trends and maintain stability, which can decrease the risk for complications and improve patient outcomes. By increasing rural health care providers' awareness of the processes required for successful CGM initiation, more patients will experience long-term benefits and a reduction in devastating complications. Methods: A quality improvement project was implemented to increase rural providers' awareness of the processes required for successful CGM initiation for patients with type 2 diabetes mellitus and insulin dependence. A workflow algorithm was developed and used to accomplish this task in one small, rural Utah clinic. An educational presentation of the workflow algorithm was first introduced to clinic staff, which consisted of office personnel, a physician, and a diabetes educator, before implementation. Pre-project data of CGM initiation were collected and compared to post-project CGM initiation data. Usability, feasibility, and satisfaction were analyzed in a post-survey provided to both clinic staff and qualified patients who participated. Results: Post-intervention, the project analysis found there was an 89.6% increase (17.4% vs 33%) in CGM initiation with the use of the workflow algorithm. Clinic staff reported 100% (n=5) in the ease of use and satisfaction with the algorithm, and 80% (n=4) reported plans for continued use. An unexpected benefit from the use of the algorithm was found when the clinic staff learned that the initiation of CGM and the interpretation of CGM data could be billed, which is something they had not done previously. Patients reported overall satisfaction (n=22, 88%) with the personal care provided, continuity of care, and their improved self-management of diabetes. Three patients reported "dissatisfied" or "very dissatisfied" (n=3, 12%) in improved self-management and overall satisfaction. Conclusions: The CGM workflow algorithm appears to be a valuable resource to help facilitate CGM initiation in a small, rural Utah clinic. Replication of this quality improvement project is needed to determine if the use of this workflow algorithm in other rural clinics would be beneficial and reflect similar results