Primary Care-Initiated CGM Associated With Lower A1C, Fewer Hospitalizations

Adults with diabetes treated with insulin who were prescribed continuous glucose monitoring (CGM) by their primary care clinician were associated with meaningful and durable improvements in hemoglobin A_1c (HbA_1C), along with fewer hospitalizations and emergency department (ED) visits, according to a cohort study published in JAMA Network Open.

“In this cohort study of adults with insulin-treated diabetes, initiation of CGM by primary care clinicians was associated with clinically meaningful improvements in HbA_1c and significant reductions in recurrent hospitalizations and ED visits,” wrote the researchers of the study. “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 analyzed 8502 CGM-naive adults with insulin-treated diabetes across 18 primary care clinics within Montefiore Medical Center, a Bronx, New York, safety-net system serving a predominantly Hispanic and non-Hispanic Black population. Patients were followed from August 2022 to August 2025; those who were uninsured or whose first CGM came from a specialist rather than primary care were excluded. More than a quarter of the cohort (28.1%) received a CGM prescription directly from a primary care clinician.

HbA1C Improvements Held Through 2 Years

At 12 months, HbA_1C fell by 0.66 percentage points (pp) among CGM initiators compared with 0.17 pp among noninitiators, a between-group difference of −0.49 pp (95% CI, −0.62 to −0.35). The gap persisted through 24 months (−0.54 pp; 95% CI, −0.72 to −0.35). Benefits were most pronounced among patients with a baseline HbA_1C above 9%, while those with lower baseline levels saw smaller shifts.

Fewer Hospitalizations and ED Visits

CGM initiation was associated with a 13% lower risk of recurrent hospitalizations (HR, 0.87; 95% CI, 0.77-0.98) and an 18% lower risk of recurrent ED visits (HR, 0.82; 95% CI, 0.74-0.91). Reductions were comparable, and in some cases larger, among patients managed exclusively in primary care without endocrinology support, suggesting that CGM can be successfully initiated in primary care settings without routine endocrinology involvement.

A Scalable Model, But Uptake Is Still Modest

Despite meeting study eligibility criteria, only 28.1% of eligible patients received a CGM prescription during the 3-year window, though that marks an increase from the 17% uptake reported in earlier work from the same research group. Authors pointed to a growing endocrinologist shortage nationally as another reason to build out primary care–based CGM pathways.

The findings carry direct relevance for payers and health systems weighing where to invest CGM education and prescribing support. Because hospitalizations account for substantial health care spending, reductions in inpatient utilization could translate into lower costs if replicated in broader populations. Separately, several Medicaid programs have begun incorporating CGM-related quality measures into diabetes improvement initiatives.² Together, the findings suggest that directing training, electronic health record–based decision support, and prescribing incentives toward primary care rather than concentrating CGM access in specialty settings may be a scalable lever for both clinical outcomes and cost containment in publicly insured populations to close access gaps in underresourced clinics.

“These results reinforce the need to integrate CGM into routine primary care practice, especially in racially and ethnically diverse and underserved populations,” wrote the researchers. “Future prospective studies are warranted to further clarify the optimal strategies for CGM implementation, clinician training, and patient education to maximize the long-term impact of CGM on clinical outcomes and health care utilization.”

References

1. Milosavljevic J, Leon LR, Rikin S, et al. Primary care–initiated continuous glucose monitoring and outcomes among adults with insulin-treated diabetes. JAMA Netw Open. 2026;9(7):e2621713. doi:10.1001/jamanetworkopen.2026.21713
2. Shaikh J. Improving diabetes care through access to continuous glucose monitors in Medicaid: state opportunities. Center for Health Care Strategies. April 2, 2025. Accessed July 1, 2026. https://www.chcs.org/improving-diabetes-care-through-access-to-continuous-glucose-monitors-in-medicaid-takeaways-from-a-convening-of-states/