Adults with insulin-treated diabetes who began continuous glucose monitoring through their primary care clinician achieved greater reductions in HbA1c and fewer hospitalisations and emergency department visits, a large study has found.
Adults with insulin-treated diabetes who received continuous glucose monitoring from their primary care doctor experienced significantly better glucose control and fewer hospital and emergency department visits than patients who did not receive the technology, US researchers say.
Their large real-world study could reignite debate over GP access to subsidised CGM prescribing in Australia.
The US cohort study, published in JAMA Network Open, followed 8502 adults with insulin-treated diabetes receiving care through 18 primary care clinics in the Montefiore Medical Center network in New York.
None had previously used CGM, and 2392 patients received their first prescription from a primary care clinician during the three-year study period.
“Continuous glucose monitoring (CGM) has become the standard of care recommended by the American Diabetes Association for patients with any type of diabetes treated with insulin,” the researchers wrote.
“Well-designed randomised clinical trials and observational data demonstrate that CGM use can reduce haemoglobin A1c (HbA1c) levels in patients with type 1 diabetes and type 2 diabetes, often without changes to medication regimen, while also improving time spent in hypoglycaemias, hospitalisations and quality of life.”
Despite the proven benefits of CGM, adoption within primary care settings remains limited, representing a critical gap between evidence and clinical practice.
“Primary care is where most people with diabetes receive their care and is often the first point of contact for diabetes management, making it an ideal setting for CGM integration.”
Patients who started CGM saw their HbA1c fall by 0.66 percentage points after 12 months, compared with a reduction of just 0.17 percentage points among patients who did not initiate CGM.
The between-group difference of 0.49 percentage points persisted for at least two years, despite CGM users having substantially poorer glycaemic control at baseline. Average HbA1c was 9.5% in the CGM group compared with 7.9% in the non-CGM group before treatment began.
The technology also translated into fewer acute care presentations. Over three years, CGM initiation was associated with a 13% reduction in recurrent hospital admissions and an 18% reduction in ED presentations.
Across the study population, more than one-third of patients experienced at least one acute care event, accounting for 8448 hospitalisations and ED visits and almost 28,000 inpatient bed days.
Importantly, patients whose diabetes was managed entirely in primary care achieved similar improvements to those who also saw endocrinologists, suggesting specialist involvement is not required for successful CGM initiation and management.
The researchers said the findings supported expanding CGM prescribing in primary care, particularly as more than 90% of people with type 2 diabetes receive most of their diabetes care from GPs and many regions face shortages of endocrinologists.
Although all participants were eligible for CGM and insured, uptake remained modest, with only 28.1% receiving a prescription during the study period.
The authors said broader adoption in primary care could improve population-level diabetes management while reducing pressure on hospitals and emergency departments.
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The findings are likely to resonate in Australia, where eligible patients can access government-subsidised CGMs through the NDSS, but prescribing restrictions mean many GPs cannot directly initiate subsidised devices, potentially delaying access for patients who rely on general practice for their diabetes care.
However, Brisbane GP Dr Gary Deed, national chair of the RACGP Diabetes Specific Interest Group, said the findings should be approached with caution when looking at their relevance to Australian practice.
“It is hard to translate this to Australian general practice other than the selected groups were using insulin – which in T2DM is the group that appears to show benefits the most – due to the cohort and selection bias involved in this trial we need to be cautious of overreaching conclusions,” he told The Medical Republic.
Dr Deed said that while GPs could already prescribe CGMs privately, access to subsidised devices remains restricted under current government funding arrangements, leaving many patients to pay the full cost.
The real issue is access to government-subsidised CGMs, not prescribing itself, he said.
“Cost issues remain as a restrictive barrier to patient access – single use CGM may cost a consumer close to $100 a fortnight,” he said.
He said CGM was an “advancing technology that is well within the bounds of general practice”.
“There are accredited courses available to GPs and primary care staff to familiarise themselves under the National Association of Diabetes Centre – a subsidiary of the Australian Diabetes Society,” he said.
The authors of the JAMA paper said there was a strong case for improving access to CGM technology for adults with insulin-treated diabetes.
“In this cohort study of adults with insulin-treated diabetes, we found that primary care–initiated CGM was associated with meaningful improvements in HbA1c levels and fewer acute health care events, mirroring the benefits observed in clinical trials and specialty care settings,” the researchers concluded.
“These results reinforce the need to integrate CGM into routine primary care practice, especially in racially and ethnically diverse and underserved populations.
“Future prospective studies are warranted to further clarify the optimal strategies for CGM implementation, clinician training, and patient education to maximise the long-term impact of CGM on clinical outcomes and health care utilisation.”
