Chase Hendrickson, MD, MPH, Vanderbilt University Medical Center, attributes gaps in continuous glucose monitoring (CGM) prescribing rates to patient demographics, endocrinologists' longer familiarity with the technology, and the availability of ancillary support in endocrine clinics.
Chase Hendrickson, MD, MPH, endocrinologist, assistant professor of medicine, and executive medical director of the Medicine Patient Care Center at Vanderbilt University Medical Center, highlights barriers in continuous glucose monitor (CGM) prescribing rates between endocrinology and primary care settings.
Why are CGM uptake rates lower in primary care settings compared with endocrinology clinics, and how can these barriers be addressed?
I recently had the chance to participate in some research that Lindsay Mayberry (PhD, MS) here at Vanderbilt led, and it was looking at CGM or continuous glucose monitoring prescribing to try to understand how that's different between a specialty practice in endocrinology—where I practice—and different primary care clinics here at Vanderbilt. And not surprisingly, we saw that there was a much higher likelihood of prescribing CGMs with endocrinology, but very importantly, that primary care providers have been catching up rapidly on that. We looked in particular at 2021 data and compare that to the year before and saw that endocrinology was prescribing only slightly more numbers of CGMs that they had compared to the year before, but that primary care had a dramatic increase in how much they were prescribing.
I think probably the barriers related to that are, one, just the patient populations. We have the most data around the benefits of CGM use for individuals with diabetes who are treated with insulin, so those folks are much more likely to end up in an endocrinology clinic, and so I think that's a big part of why endocrinology prescribes that more, because of having more patients on insulin. I think another part of it is endocrinologists have been used to this technology for a lot longer. In the earlier iterations of that, where it wasn't quite as effective, it was a little bit more challenging to use, we tended to use it a lot more so that even as the newer devices have come online, we just had a head start on being familiar with those. Those are 2 really big reasons why endocrinology prescribes that more.
I think another reason this would be more of a barrier is that it can sometimes be challenging to know what to do with that information, how to get these individuals started on them in the first place, and often the ancillary support that is in endocrine clinics helps with that. In our clinic, for example, we've got diabetes educators, we have pharmacists who are very well versed with not only being able to get coverage for these devices but to instruct patients on how to use them and what to do with that data. Probably the biggest barrier is that, while we may have lots of primary care providers who are familiar with these devices, they may not have quite all of that ancillary support and staff in their clinic that may help them be able to start these devices for their patients.