New Study Opportunities

Research Update

CGMs and a New Management Portal For Care

​

A generous multi-year grant from the Hankey Foundation allowed us to expand the team’s work to treat patients with type 1 and type 2 diabetes using remote continuous glucose monitors (CGM) in East Los Angeles. The goal is to prove the benefit of remote CGM and our Tele-CGM model across a greater population, and to show that such monitoring improves and saves lives with the goal of encouraging others to adopt remote CGM. This support, coupled with state policy change, means that more of our under-resourced patients with diabetes in Los Angeles now have access to CGM sensors and use automated insulin system pumps. With the right tools, resources, and education, preliminary results show that outcomes have improved.

 

To date, the program has met its goal and has enrolled 200 individuals with Libre CGMs. The onboarding process includes finding suitable patients—often through referrals; verifying a diabetes diagnosis; educating participants on using the CGM system; and giving the individual a blinded CGM so they do not change their behavior during the initial baseline period. Dr. Peters reviews the data and then makes recommendations to the primary care physician in relation to education, nutrition, medications, and the frequency of follow-ups. Dr. Peters strives to work closely with referring physicians and primary care doctors. Some providers respond to recommendations and make changes immediately, but some are less responsive. The team is investigating ways to better educate other providers on the system and the importance of diabetes monitoring to maintain patients’ health and avoid complications and hospitalizations. To increase the responsiveness of primary care physicians, the team is trying different modes of communication, such as emails, notes in patients’ electronic medical records, and in some cases communicating through a pharmacy, since pharmacists sometimes monitor patients.

 

Early Signs of Improvements

​

Although data collection and analysis are at an early stage, all but one of the 200 individuals using the CGMs so far report favorable experiences of:

•     Fewer fingersticks (the sensors last 14 days on the arm or belly and the individual or a family member can be trained to place them)

•     The ability to see where their glucose levels are at any given minute and the ability to react to that level immediately and know whether to eat more or skip that second helping, which provides the users with a greater sense of control.

•     With more data given the continuous monitoring and more efficient monitoring given the CGM. platform’s dashboard, Dr. Peters can be more involved in care as needed for each patient, which allows her to personalize any drugs required and avoid interactions with other drugs individuals may be taking for other conditions.

 

Based on early data, the team has shown that CGM monitoring and their Tele-CGM system have improved glucose time in range for 99 of 135 (73%) people at 6 months. The new system also improved average A1c levels (a measure of average glucose levels over three months) from 8.8% to 7.7%. The range of A1c at baseline was 5.1% to 13.6%.

 

A small number of participants that did not demonstrate improvement, this could have been due to a few factors: the provider may not have made any of the suggested medication changes, or the patient may not have been taking the prescribed medications. Nine of the patients with a decrease were still in range at 70% or more. Over the next few months, the team will further analyze their data to determine what happened in each case and determine out how to improve their outcomes even more.

 

Ultimately, the team hopes to show, as they analyze the data, that the CGMs and the Tele-CGM system make it possible to provide better care, reduce the risk of depression and hospitalizations, and improve quality of life.