Primary Care CGM Linked to Better HbA1c and Fewer Acute Visits

Key Takeaways

• Primary care CGM initiation was associated with larger 12-month HbA1c declines, with reductions of 0.66 percentage points among initiators and 0.17 percentage points among noninitiators.
• CGM initiation was also associated with lower risk of recurrent hospitalizations and emergency department visits during follow-up.
• The authors concluded that these findings support broader CGM implementation in primary care, particularly for underserved populations.

Among adults with insulin-treated diabetes, primary care-initiated continuous glucose monitoring was associated with a 0.49 percentage-point greater HbA1c reduction at 12 months than no CGM initiation. Investigators evaluated care across 18 primary care clinics within Montefiore Medical Center, a large safety-net system in the Bronx, New York.

This cohort study examined first CGM prescribing by primary care clinicians in adults aged 18 years or older with insulin-treated diabetes. Eligible patients had at least 1 primary care visit between August 1, 2022, and August 1, 2025. Exclusions included uninsured patients, those with a CGM prescription during the prior 2 years, and those whose first CGM prescription during follow-up came from outside primary care. The final cohort included 8,502 CGM-naive adults, and 2,392 patients, or 28.1%, received CGM from primary care clinicians. Mean age was 62.3 years, 56.0% were female, 42.6% had Medicare, and 33.6% had Medicaid coverage. Patients who initiated CGM were younger, more often English-speaking and commercially insured, and had higher baseline HbA1c levels and more microvascular complications.

HbA1c trajectories were a primary outcome. At 12 months, HbA1c decreased by 0.66 percentage points in patients who initiated CGM and by 0.17 percentage points in those who did not. The between-group difference was minus 0.49 percentage points, with a 95% CI from minus 0.62 to minus 0.35. These 12-month glycemic results favored CGM initiation.

Hospitalizations and emergency department visits were also primary outcomes. CGM initiation was associated with a lower risk of recurrent hospitalizations, with a hazard ratio of 0.87 and a 95% CI of 0.77 to 0.98. It was also associated with fewer recurrent emergency department visits, with a hazard ratio of 0.82 and a 95% CI of 0.74 to 0.91. In this primary care-initiated CGM cohort study, the authors concluded that the findings support expanding CGM implementation in primary care, particularly in underserved populations.