Diabetes Telehealth Solutions: Improving Self-management Through Remote Initiation of Continuous Glucose Monitoring

Improving Self-Management Through Remote Initiation of Continuous Glucose Monitoring

Robin L. Gal; Nathan J. Cohen; Davida Kruger; Roy W. Beck; Richard M. Bergenstal; Peter Calhoun; Terra Cushman; Amanda Haban; Korey Hood; Mary L. Johnson; Teresa McArthur; Beth A. Olson; Ruth S. Weinstock; Sean M. Oser; Tamara K. Oser; Brian Bugielski; Heidi Strayer; Grazia Aleppo


J Endo Soc. 2020;4(9) 

In This Article

Abstract and Introduction


The purpose of this study was to evaluate feasibility of initiating continuous glucose monitoring (CGM) through telehealth as a means of expanding access. Adults with type 1 diabetes (N = 27) or type 2 diabetes using insulin (N = 7) and interest in starting CGM selected a CGM system (Dexcom G6 or Abbott FreeStyle Libre), which they received by mail. CGM was initiated with a certified diabetes care and education specialist providing instruction via videoconference or phone. The primary outcome was days per week of CGM use during the last 4 weeks. Hemoglobin A1c (HbA1c) was measured at baseline and 12 weeks. Participant self-reported outcome measures were also evaluated. All 34 participants (mean age, 46 ± 18 years; 53% female, 85% white) were using CGM at 12 weeks, with 94% using CGM at least 6 days per week during weeks 9 to 12. Mean HbA1c decreased from 8.3 ± 1.6 at baseline to 7.2 ± 1.3 at 12 weeks (P < .001) and mean time in range (70–180 mg/dL, 3.9–10.0 mmol/L) increased from an estimated 48% ± 18% to 59% ± 20% (P < .001), an increase of approximately 2.7 hours/day. Substantial benefits of CGM to quality of life were observed, with reduced diabetes distress, increased satisfaction with glucose monitoring, and fewer perceived technology barriers to management. Remote CGM initiation was successful in achieving sustained use and improving glycemic control after 12 weeks as well as improving quality-of-life indicators. If widely implemented, this telehealth approach could substantially increase the adoption of CGM and potentially improve glycemic control for people with diabetes using insulin.


Telehealth provides an opportunity to increase access to continuous glucose monitoring (CGM) and empower patients living with diabetes by providing more data for self-management. Despite the compelling evidence of the benefits of CGM,[1–15] many individuals with type 1 diabetes (T1D) or type 2 diabetes (T2D) using insulin have not adopted the use of CGM.[6,16] Many adults with T1D and most adults with T2D do not regularly see an endocrinologist and receive their diabetes care from their primary care provider.[17–19] Limited CGM awareness among primary care providers may be a factor responsible for the low rate of CGM adoption, particularly in areas where geography affects access to endocrinologists.[19]

Training for the initiation of CGM has become easier with advances in CGM technology, including easily inserted, factory-calibrated sensors, making it potentially feasible to initiate CGM through a telemedicine approach. The ability for participants to view their reports on an ongoing basis provides them the opportunity to identify trends and make adjustments, while the ability to share CGM data with providers presents the opportunity to review data not only during but also between visits. With the goal of expanding access to CGM, we conducted a feasibility study to assess whether adults with T1D or T2D using insulin could be trained virtually, outside the routine practice where the individual receives diabetes care, to initiate and use CGM as part of their diabetes self-management. This work predates the current COVID-19 pandemic, but it is even more pertinent now when a telehealth approach is needed to afford access and continuity of care.