Continuous glucose monitors (CGMs) have revolutionized type 1 diabetes care and improved health and psychological outcomes, yet there are major racial and ethnic disparities in prescriptions that limits CGM use among underserved populations.

In a study published online on September 2 in Diabetes Care, Shivani Agarwal, M.D., M.P.H., Priyanka Mathias, M.D., and Lakshmi Priyanka Mahali, M.D., examined whether practice transformations to address structural healthcare barriers would change provider prescribing behaviors to make CGM access more equitable.

Over a three-year period, the Fleischer Institute for Diabetes and Metabolism at Montefiore Einstein convened multi-level stakeholders including leadership, practice staff, clinicians, and patients to plan and implement several non-grant funded practice transformations targeted toward equity to improve CGM prescription equity. Interventions included developing a specialty type 1 diabetes clinic; conducting social needs assessment and management; training support staff to trial CGMs at the point of care; improving CGM prescribing workflows; and educating providers on the use and benefits of CGM. Results demonstrated that over the study period, in 1,357 underserved adults with type 1 diabetes treated at Montefiore Medical Center, CGM prescription rates quadrupled from 15% to 69%, and improvements were seen equally among Black, Hispanic, and white adults.

The authors concluded that this novel approach using stakeholder-engaged methods to transform the diabetes practice can be highly effective to target upstream determinants of racial-ethnic disparities among underserved adults with type 1 diabetes.

Dr. Agarwal is an associate professor of medicine and associate director of the Fleischer Institute for Diabetes and Metabolism at Montefiore Einstein. Dr. Mathias is an assistant professor of medicine at Einstein. Dr. Mahali is a former clinical endocrinology fellow at Einstein.