Closing the Gap in Diabetes Specialty Care

      Across the United States, the shortage of endocrinologists is a growing barrier to optimal diabetes management. The challenge is even greater in safety-net hospital settings, where patients—often from racial and ethnic minority groups—face long wait times, missed appointments, and limited access to specialist care.

      Boston Medical Center’s innovative solution: Continuous Glucose Monitoring (CGM)-enhanced eConsults—a system where primary care teams collaborate virtually with endocrinologists, supported by detailed CGM data, to deliver specialist-level recommendations without requiring in-person visits.

      Study Overview

• Population: 67 adults with diabetes
  • Mean age: 65 years
  • 79.1% Black
  • 92.5% with type 2 diabetes
• Setting: General Internal Medicine Clinic at Boston Medical Center
• Intervention: Professional CGM (Freestyle Libre Pro) placed by pharmacists → data reviewed by endocrinologists → recommendations sent electronically to PCPs
• Study Design: Retrospective observational analysis (April 2023 – January 2024)
• Primary Goals:
  • Measure speed of specialist input
  • Assess adoption of endocrinology recommendations
  • Evaluate changes in medications, CGM use, and glucose outcomes

      Results That Matter

1. Timely Specialist Input
   • • Average turnaround: 5.8 days from eConsult request to completed recommendation
   • • Implementation rate:
     • o 86.6% at the first follow-up visit
     • o 94.0% within 6 months
2. Modernizing Medication Therapy
   • Sulfonylurea prescriptions: ↓ 55.6% (reducing risk of hypoglycemia)
   • Basal insulin dose reductions: in 41.8% of patients (without loss of control)
   • Bolus insulin use: ↑ 56.3% (better mealtime glucose coverage)
   • Significant uptake of GLP-1 RAs and SGLT2 inhibitors in line with ADA guidelines
3. Technology Adoption Surge
   • Personal CGM prescriptions ↑ from 2.9% at baseline to 49.3% at 6 months (17-fold increase)
   • Two-thirds of CGM users shared data with clinicians; half had sufficient data for analysis
4. Hypoglycemia Reduction (in analyzable CGM users):
   • Level 1 hypoglycemia (54–69 mg/dL) time ↓ from 81.8% of patients affected at baseline to 27.3% at 6 months
   • Absolute reduction: 2% for Level 1, 0.7% for Level 2 (<54 mg/dL)
   • Only 1 patient had increased time below range

      Why This Model Works

1. Data-Driven Decision Making
   CGM captures 24/7 glucose trends, revealing hidden hypoglycemia, post-meal spikes, and mismatches between HbA₁c and actual patterns.
2. Specialist Expertise Without the Wait
   eConsults bypass months-long waits and high no-show rates for in-person endocrinology visits.
3. Primary Care Empowerment
   PCPs receive precise, individualized recommendations they can implement immediately.
4. Patient-Centered & Accessible
   Minimizes travel, reduces health system costs, and integrates care into the patient’s existing primary care relationship.

      GEMS Perspective

      This isn’t just about technology—it’s about equity in diabetes care. CGM-enhanced eConsults can:

• Expand access to guideline-based, specialist-level care for underserved populations
• Accelerate the adoption of modern therapies and digital health tools
• Reduce avoidable hypoglycemia and treatment delays
• Serve as a scalable model for primary care systems worldwide

      GEMS Takeaway

      In the right hands, CGM + eConsult = faster, more accurate, and more equitable diabetes care. This Boston Medical Center experience proves that virtual collaboration—powered by continuous glucose data—can close the gap between primary care and endocrinology, making expert care available to those who need it most.