Continuous Glucose Monitoring–Enhanced eConsult Improves Clinical Outcomes in Adults Living With Diabetes in a Safety Net Primary Care Setting

Background: There is a shortage of endocrinologists providing diabetes care. Electronic consultation (eConsult) improves access to subspecialty care, but the evaluation of CGM‐enhanced eConsults in routine clinical practice has not been reported. We evaluated clinical outcomes after implementing a CGM‐enhanced eConsult program in a safety‐net hospital primary care clinic. Methods: We completed a retrospective observational study assessing the clinical impact of the eConsult program. Participants included 67 adults (≥ 18 years) living with diabetes, receiving primary care at Boston Medical Center (mean age 65 years, 40.3% male, 79.1% Black, and 92.5% Type 2 diabetes). Demographic, clinical, and CGM data were analyzed from the medical record and Abbott’s LibreView and Dexcom’s Clarity web‐based applications. Descriptive outcomes within 6 months post‐eConsult included time to eConsult completion, hemoglobin A1c (HbA1c) change, medication adjustments, CGM prescription rates, and CGM‐derived hypoglycemic metrics. Results: Mean time to eConsult completion was 5.8 days. Endocrinologist recommendations were implemented in 86.6% of patients at the first primary care visit post‐eConsult and in 94.0% of patients within 6 months. Within 6 months, HbA1c was unchanged (mean change 0.2 % ± 0.4 % ). Relative to baseline, sulfonylurea prescription decreased 55.6%. The percentage of those prescribed basal insulin was unchanged, but basal insulin doses decreased in 41.8% of patients. Bolus insulin prescription increased 56.3% relative to baseline. Absolute CGM prescriptions increased from 2.9% at baseline to 49.3%. In 11 CGM users with sufficient CGM data for interpretation at 6 months, Level 1 hypoglycemia (54–69 mg/dL) decreased by 2% and Level 2 hypoglycemia (< 54 mg/dL) decreased by 0.7%. Conclusion: In adults living with diabetes cared for in a safety‐net hospital, CGM‐enhanced eConsult provides timely access to endocrinologist expertise, recommendations are widely implemented by primary care clinicians, and guideline‐directed modern diabetes therapeutic use increases, including a 17‐fold increase in personal CGM prescriptions.