Development and Evaluation of a Nurse Practitioner Directed Glycemic Improvement Initiative in a Rural Diabetes Specialty Care Clinic

Diabetes with poor glycemic control is a growing health concern for many communities. Improving glycemic control for patients with diabetes can prevent complications, improve health outcomes, and reduce overall diabetes disease burden. Continuous glucose monitoring (CGM) can improve glycemic control and evidence supports expansion of CGM using shorter periods and to all patients with diabetes. This project implemented CGM for patients in a rural diabetes clinic and evaluated glycemic control before and after use. All participants had type 2 diabetes (T2DM) and 75% observed improvement in glycemic control. Before CGM implementation, the average hemoglobin HgbA1C was 8.2%. This decreased to 7.1% postintervention. Statistically significant improvements were observed in those patients with CGM active at least 79% of the intervention period and in those with higher baseline HgbA1C levels. Subjectively, several patients reported that the CGM information empowered them to make healthy lifestyle changes and was a key factor in glycemic control improvement. Sample size, population diversity, and inability to control for medication changes were major limitations of this project. Despite these limitations, implementing CGM led to an improvement in glycemic control for most patients. Most profound improvements were seen among patients who utilized CGM consistently. The influence of pharmacologic and lifestyle factors on project outcomes was not able to be determined within the project design. Further areas for investigation include assessing CGM use on a larger scale, focusing on CGM use with type 2 diabetes, and controlling for pharmacologic and lifestyle factors. CGM is an evidence-supported, sustainable, and practical intervention to improve glycemic control, particularly among patients with type 2 diabetes.