Inequity in Continuous Glucose Monitor (CGM) Prescribing Behaviors in Primary Care

BACKGROUND: Continuous glucose monitoring (CGM) has become a standard of care for diabetes management, yet its adoption in primary care remains limited where the majority of people with diabetes are served. Examining contributors to CGM prescriptions in primary care may identify new targets for intervention that could improve diabetes population health. OBJECTIVE: To determine factors associated with CGM prescription by primary care providers (PCPs) in a safety-net primary care practice network serving over 11,000 adults with insulin-treated type 2 diabetes. DESIGN: Retrospective cohort study. PATIENTS: Adults with type 2 diabetes treated with insulin with at least one primary care visit between July 31, 2020, and July 31, 2023, in a safety-net primary care clinic network in the Bronx, NY. MAIN MEASURES: Primary outcome was first-time CGM prescription by PCPs. Multivariable analysis was performed using cause-specific Cox regression, with death and prescriptions by endocrinology treated as censoring events. RESULTS: Among 11,037 insulin-treated patients (mean age 61 ± 14 years; 56% female; 44% Hispanic, 39% non-Hispanic Black), 17% received first-time CGM prescriptions from primary care, with a median monthly prescription rate of 3.1% (2.8-3.3%). Older patients, Spanish-speaking, and publicly insured had a lower likelihood of receiving CGM prescription. Conversely, patients with higher HbA1c levels, more intensive insulin regimens, and providers with more years in practice were more likely to receive CGM regardless of race-ethnicity. CONCLUSIONS: CGM prescribing rates in primary care remain low, with inequity that favored younger, English-speaking, commercially insured patients, and more experienced providers. We have highlighted gaps in workflow efficiency, language and age-appropriate training support, and trainee education as key next steps to address in order to increase CGM prescriptions in primary care practice. Addressing inequitable CGM prescribing patterns is a critical first step to elevating the standard of diabetes care in primary care practice and breaking the cascade of inequity in outcomes for underserved diabetes populations.