CGM prescribed by primary care lowers A1C and acute care use in diabetes patients

Patients whose primary care physicians initiate the use of continuous glucose monitoring (CGM) experience a decrease in hemoglobin A1C levels, as well as lower rates of hospitalizations and emergency department visits, according to a recent study published in JAMA Network Open.

“These findings support expanding CGM implementation in primary care settings as a scalable strategy to improve diabetes outcomes and reduce acute care utilization, particularly in underserved populations,” researchers wrote.

Researchers were led by Jovan Milosavljevic, M.D., assistant professor in the division of endocrinology, Albert Einstein College of Medicine and Montefiore Medical Center in New York.

Milosavljevic and his colleagues wanted to evaluate the impact of primary care physicians initiating patient use of CGM on A1C and healthcare utilization. In this cohort study, 8,502 insulin-treated adult patients with diabetes who didn’t use CGM were included for analysis. Patients were treated at 18 primary care clinics within Montefiore Medical Center, a health system in the Bronx that predominantly serves patients who are Hispanic and Black.

Patients were identified through the electronic medical records. Included were patients who had at least one primary care visit between Aug. 1, 2022, and Aug. 1, 2025; 42.6% had Medicare coverage and 33.6% had Medicaid coverage. Researchers note that CGM is covered under Medicaid and Medicaid-managed insurance plans in the state of New York for patients with diabetes receiving insulin.

In total, 2,392 patients, or 28.1%, were prescribed CGM by primary care clinicians. Patients who initiated CGM use were younger, more often English-speaking and commercially insured, and had higher baseline HbA1c levels and more microvascular complications.

At 12 months, patients who had been prescribed CGM experienced a decrease in A1C by 0.66 percentage points compared with a 0.17 percentage point decrease in patients who did not begin using CGM. Researchers found that the improvement continued through two years.

CGM initiation was also associated with a lower risk of recurrent hospitalizations and emergency department visits. During the three-year follow-up, there were 8,448 total acute care events, including 4,619 emergency department visits and 3,829 hospitalizations. Among the patients in the study, 3,015, or about 35%, experienced at least one hospitalization or emergency department visit. Initiation of CGM was associated with a 13% lower risk of recurrent all-cause hospitalizations and an 18% lower risk of recurrent ED visits.

The lower utilization of healthcare services leads to significant cost savings, researchers said. During the three-year study, patients had 27,973 inpatient days, with a median length of stay of 4.9 days. “Acute care reductions may reflect improvements in medication self-management, earlier detection of hypoglycemia and hyperglycemia, and avoidance of diabetes-related crises,” they wrote.

The benefits, researchers said, were seen despite potential barriers, including language barriers, socioeconomic challenges, and limited access to specialty care.

One limitation, however, is the electronic medical record captured CGM prescriptions, and researchers said they did not track usage of the device. The research captured hospitalizations and emergency room events within the health system; researchers said that potential treatment for these events outside the health system may be missing. Additionally, uninsured patients were not included in this analysis.