UTILIZING CONTINUOUS GLUCOSE MONITORING TO IMPROVE A1C FOR DIABETES TYPE 2 PATIENTS
Date
2024
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Abstract
Background & Significance: Daily finger sticks improve A1C levels by helping patients understand glucose response. Nonadherence may be due to inconvenience, pain, discomfort, fear, forgetfulness, or disinterest. The use of CGM at a community health center in Hawaiʻi was uncertain.
Purpose & Aim:
The pilot project aimed to determine if CGM could improve A1C and satisfaction for type 2 diabetes patients.
Methods & Approach:
This DNP project addressed the use of CGM at Kalihi Palama Health Center for patients with A1C ≥ 9%, who were prescribed insulin, and insured by Medicaid/Quest. Participants were monitored for 3 months with bi-weekly follow-ups to discuss CGM, behavior changes, medications, and plans. Providers, nurses, patients, and pharmacies were engaged. Surveys measured A1C, perceptions, and satisfaction.
Results & Outcomes:
The baseline A1C of eight participants was between 9.8% and 13.6% (median 12%). All patients (100%) improved with A1C levels ranging from 7.6% to 11.5% (median 8.9%). Impact and outcome evaluations surveying perceptions of CGM and lifestyle/behavior improved (100%). No adverse effects observed. Of 72 scheduled appointments, 15 were missed (20%).
Conclusions:
CGM improved decision-making, behavior, medication adherence, A1C, and satisfaction, aligning with the literature. Outcomes improved, but additional participants are needed to strengthen conclusions. Patients with low health literacy or language barriers needed longer appointment times, and technical issues with CGM required extra assistance.
Implications & Recommendations:
CGM is recommended for uncontrolled diabetes prescribed insulin. It offers real-time data replacing frequent finger sticks and facilitates daily glucose monitoring. Collaborating with other providers and updating health plans can boost CGM adoption and reduce prior authorization hurdles.
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Nursing, Medicine, Health care management, A1C, CGM, continuous glucose monitor, diabetes type 2, Hawaii, Medicaid
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53 pages
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