Introduction and Objective: Continuous glucose monitoring (CGM) has demonstrated benefits in type 2 diabetes (T2D) with A1c reduction of about 0.3% in trials conducted largely in insured populations. Structural barriers, particularly cost, limit CGM access among underinsured adults who may stand to benefit the most. This pilot study evaluated whether providing CGM to underinsured patients with poorly controlled T2D at a federally qualified health center (FQHC) is associated with improvements in A1c and patient-reported outcomes (NCT06658067). Methods: In a single-arm trial, adults with T2D, A1c ≥8.0%, and insulin use for ≥1 year who could not afford CGM were recruited from Fair Haven Community Health Care in New Haven, CT and provided with Dexcom G7 sensors for 90 days. Participants without a smartphone were provided a reader. All participants were trained in application and use of CGM. CGM data were reviewed and medication regimen adjusted by a primary care physician at 6 weeks. Primary outcomes were change in A1c and Illness Intrusiveness Ratings Scale (IIRS) after 90 days. Secondary outcomes were changes in Diabetes Distress (DDS17), Treatment Burden (TBQ+D), and quality-of-life (analog scale) survey scores. Changes were assessed using paired t-tests. Results: Among 17 participants, mean age was 56, 47% were women, 94.1% preferred Spanish for communication. Baseline A1c ranged from 8.1 to 13% with a mean of 10.4% (SD 1.7). Mean A1c decreased by 1.8% (p = 0.0002) to 8.7% (SD 1.5). There were no significant changes in IIRS (-8.5, p = 0.09), DDS17 (-7.1, p = 0.12), TBQ+D (-13.2, p = 0.44), or quality of life (0.07, p = 0.93). Conclusion: In this pragmatic pilot study conducted at an FQHC, providing CGM to underinsured adults with poorly controlled T2D was associated with substantial short-term reductions in A1c. Although causal inference is limited in a single-arm design, the magnitude of A1c reduction exceeds that reported in CGM trials conducted in insured populations. Expanding CGM access may be a strategy to improve glycemic control and address inequities in diabetes care. Disclosure J.A. Dower: None. M.E. Ochoa Prieto: None. T. Correa Gaviria: None. A.M. Montosa: None. A. Camp: None. K. Lipska: None. Funding Yale School of Medicine Office of Global Health Yogesh Khanal Pilot Project Award
Dower et al. (Fri,) studied this question.