Implementation of a pharmacist-driven continuous glucose monitoring program within an American Indian/Alaska Native community

Abstract

Introduction

Ambulatory care pharmacists can help overcome systemic barriers in diabetes management for American Indians and Alaska Natives (AI/AN) by facilitating the adoption and management of continuous glucose monitoring (CGM) technology. Despite the proven clinical benefits of CGM, its use in AI/AN populations remains limited and underexplored. The aim of this study was to evaluate the impact of a pharmacist-driven CGM program on glycemic control in AI/AN patients with diabetes and to characterize the implementation of the intervention in clinical practice.

Methods

This is a retrospective, single-center, observational study using data from a pharmacist-driven CGM program at a rural, Indian Health Service, ambulatory health center in the midwestern United States serving AI/AN individuals. The study included a pilot phase with a matched-cohort design and a subsequent post-pilot implementation. Participants in the intervention group received comprehensive CGM education and management from clinical pharmacists, with follow-up visits for 6 months. The primary outcome was the change in hemoglobin A1c (HbA1c) levels, analyzed using multilevel linear regression models.

Results

In the pilot phase, 79% of the intervention group achieved a 1% reduction in HbA1c at 6 months, with an average reduction of 2%. The control group showed no significant change (p = 0.032 for CGM vs. control arms). Post-pilot implementation maintained these improvements, with a mean HbA1c reduction of 1.5% in a larger patient cohort (p < 0.001 for pre- vs. post-CGM implementation). Patient confidence in managing diabetes and satisfaction with care also increased.

Conclusion

Implementing a pharmacist-driven CGM program in AI/AN communities can address health care disparities and improve diabetes outcomes. This model holds promise for broader application in managing chronic diseases in underserved populations, highlighting the critical role of pharmacists in interdisciplinary health care teams. Further research should focus on long-term outcomes and economic impacts to support the widespread adoption of this approach.