1
|
Fantasia KL, Stockman MC, Ju Z, Ortega P, Crable EL, Drainoni ML, Walkey AJ, Bergstrom M, O'Brien K, Steenkamp D. Professional continuous glucose monitoring and endocrinology eConsult for adults with type 2 diabetes in primary care: Results of a clinical pilot program. J Clin Transl Endocrinol 2021; 24:100254. [PMID: 33898271 PMCID: PMC8054187 DOI: 10.1016/j.jcte.2021.100254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/03/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Abstract
Background Limitations in access to specialty diabetes care exist. Endocrinology eConsult that integrates professional continuous glucose monitoring (CGM-enhanced eConsult) may improve healthcare delivery, but has yet to be evaluated. We implemented a pilot program for patients with type 2 diabetes (T2DM) managed by primary care clinical pharmacists using CGM-enhanced eConsult and evaluated the acceptability and clinical outcomes in comparison to routine in-person endocrinology consultation. Methods Seventy-four adult patients with established T2DM (age 18-65) were included. Twenty-nine were seen in-person by endocrinology and 45 were seen by pharmacists in primary care. Thirteen patients were referred for CGM-enhanced eConsult. Acceptability was assessed with pre/post clinician acceptability questionnaires and patient assessment of perceived burden. Clinical outcomes included time to first specialty appointment, baseline and 3-month follow-up HbA1c, and antihyperglycemic medication use. Results There were no differences in patient acceptability of the CGM-enhanced eConsult as compared to endocrinology referral or pharmacy care. At baseline, all patients referred for eConsult were prescribed insulin. Three-month glycemic outcomes were comparable, with HbA1c reduction 1% + 2% in endocrinology, 1.5% + 1.1% with CGM-enhanced eConsult, and 1.6% + 1.8% in clinical pharmacy (p = 0.19). Time to an initial diabetes visit with a pharmacist was significantly shorter than with endocrinology, 20 days (IQR 26) for pharmacy vs. 45 days (IQR 54) for endocrinology, (p = 0.0001). Conclusions CGM-enhanced eConsult resulted in more timely access to endocrinology expertise, was acceptable to patients, and resulted in similar short-term glycemic outcomes compared to in-person consultation. Effectiveness of CGM-enhanced eConsults should be further explored.
Collapse
Key Words
- BMC, Boston Medical Center
- BMI, Body mass index
- CGM, Continuous glucose monitoring
- Certified diabetes educators
- DPP-4, Dipeptidyl peptidase-4
- Diabetes mellitus, type 2
- ED, Emergency department
- EMR, Electronic medical record
- GLP-1 RA, glucagon-like peptide-1 receptor agonist
- HbA1c, Hemoglobin A1c
- IQR, Interquartile range
- Pharmacists
- Professional continuous glucose monitoring
- Referral and consultation
- eConsult, Electronic consultation
Collapse
Affiliation(s)
- Kathryn L Fantasia
- Boston University School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, United States
| | - Mary-Catherine Stockman
- Boston University School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, United States
| | - Zhihui Ju
- Boston University School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, United States
| | - Paola Ortega
- Boston University School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, United States
| | - Erika L Crable
- Boston University School of Medicine, Department of Medicine, Evans Center for Implementation and Improvement Sciences, United States.,Boston University School of Public Health, Department of Health Law, Policy & Management, United States
| | - Mari-Lynn Drainoni
- Boston University School of Medicine, Department of Medicine, Evans Center for Implementation and Improvement Sciences, United States.,Boston University School of Medicine, Department of Medicine, Section of Infectious Diseases, United States.,Boston University School of Public Health, Department of Health Law, Policy & Management, United States
| | - Allan J Walkey
- Boston University School of Medicine, Department of Medicine, Evans Center for Implementation and Improvement Sciences, United States.,Boston University School of Public Health, Department of Health Law, Policy & Management, United States.,Boston University School of Medicine, Department of Medicine, The Pulmonary Center, United States
| | - Megan Bergstrom
- Boston Medical Center, Department of Pharmacy, Section of General Internal Medicine, United States
| | - Katelyn O'Brien
- Boston Medical Center, Department of Pharmacy, Section of General Internal Medicine, United States
| | - Devin Steenkamp
- Boston University School of Medicine, Department of Medicine, Section of Endocrinology, Diabetes, Nutrition and Weight Management, United States
| |
Collapse
|