Primary Care CGM Linked to Better Diabetes Outcomes

Key Takeaways

• Among adults with insulin-treated diabetes, 12-month HbA1c decreased by 0.66 percentage points with primary care–initiated continuous glucose monitoring (95% CI 0.57-0.75) versus 0.17 percentage points without continuous glucose monitoring (95% CI 0.08-0.27), for a reported between-group difference of 0.49 percentage points.
• Primary care initiation of continuous glucose monitoring was associated with lower recurrent hospitalization risk (HR 0.87; 95% CI 0.77-0.98) and lower emergency department visit risk (HR 0.82; 95% CI 0.74-0.91) in adults with insulin-treated diabetes.
• In a JAMA Network Open analysis across 18 primary care clinics involving 8,502 adults with insulin-treated diabetes, 28.1% were prescribed continuous glucose monitoring by their primary care physician, and initiators entered the cohort with higher baseline HbA1c, more diabetes complications, and greater acute care use.

In a JAMA Network Open analysis, adults with insulin-treated diabetes who started CGM in primary care had a 0.49 percentage-point greater reduction in HbA1c at 12 months than those who did not start CGM, alongside lower recurrent hospitalization and emergency department visit risk.

The analysis included 8,502 adults with insulin-treated diabetes across 18 primary care clinics, all with at least one primary care visit between Aug. 1, 2022, and Aug. 1, 2025. The cohort had a mean age of 62.3 years, 56% were women, and 28.1% were prescribed CGM by their primary care physician, placing the findings in a broad real-world primary care population.

Investigators noted that CGM initiators had higher baseline HbA1c levels, a greater burden of diabetes complications, and higher acute care utilization than noninitiators, yet the associations with lower acute care use were still observed in a population facing language barriers, socioeconomic challenges, and limited access to specialty care.

According to the authors, the pattern may reflect improved medication self-management, earlier detection of hypoglycemia and hyperglycemia, and avoidance of diabetes-related crises, although the analysis was observational and some CGM users may not have used the device properly, which could attenuate the associations and underestimate outcomes linked to CGM use.

Clinician Questions

How much greater was the 12-month HbA1c reduction when continuous glucose monitoring was started in primary care for adults with insulin-treated diabetes?

In the 18-clinic analysis of 8,502 adults with insulin-treated diabetes, HbA1c at 12 months decreased by 0.66 percentage points among continuous glucose monitoring users and by 0.17 percentage points among nonusers, for a reported between-group difference of 0.49 percentage points, which the investigators described as an observed association.

Was primary care initiation of continuous glucose monitoring associated with fewer recurrent hospitalizations or emergency department visits in insulin-treated diabetes?

The investigators reported lower acute care utilization with continuous glucose monitoring initiation in adults with insulin-treated diabetes, with recurrent hospitalization risk HR 0.87 (95% CI 0.77-0.98) and emergency department visit risk HR 0.82 (95% CI 0.74-0.91), and they presented these findings as associations rather than proof of causation.

What population was included in the JAMA Network Open analysis of continuous glucose monitoring initiation in primary care?

The analysis involved 8,502 adults with insulin-treated diabetes across 18 primary care clinics, all with at least one primary care visit between Aug. 1, 2022, and Aug. 1, 2025; the mean age was 62.3 years, 56% were women, and 28.1% were prescribed continuous glucose monitoring by their primary care physician.

What baseline differences and cautions were reported for continuous glucose monitoring initiators versus noninitiators in this primary care diabetes cohort?

Continuous glucose monitoring initiators were described as having higher baseline HbA1c levels, a greater burden of diabetes complications, and higher acute care utilization than noninitiators, and the investigators added that some continuous glucose monitoring users may not have used the device properly, which could attenuate the associations and underestimate outcomes linked to continuous glucose monitoring use.

Recommended Reading

• For more on HbA1c-lowering diabetes therapy: Oral Elecoglipron Trial Reports Glycemic And Weight Loss Gains