Primary Care–Initiated CGM Linked to Better Diabetes Outcomes, Lower Acute Care Use

Primary care–initiated continuous glucose monitoring (CGM) was associated with improved glycemic control and reduced acute health care utilization among adults with insulin-treated diabetes, according to findings published in JAMA Network Open.

In a cohort study of 8502 insulin-treated, CGM-naive adults with diabetes seen at 18 Montefiore Medical Center primary care clinics in the Bronx, New York, 2392 patients, or 28.1%, were prescribed CGM by primary care clinicians during the study period. At 12 months, HbA1c levels decreased by 0.66 percentage points among CGM initiators compared with 0.17 percentage points among noninitiators, for a between-group difference of –0.49 percentage points.

CGM initiation also was associated with lower acute care use over 3 years. Patients prescribed CGM had a 13% lower risk of recurrent all-cause hospitalizations (HR, 0.87; 95% CI, 0.77-0.98) and an 18% lower risk of recurrent emergency department (ED) visits (HR, 0.82; 95% CI, 0.74-0.91).

The findings are clinically relevant because most diabetes care is delivered in primary care, yet CGM adoption has historically been concentrated in endocrinology settings. The study authors noted that CGM is recommended by the American Diabetes Association for patients with any type of diabetes treated with insulin, but adoption in primary care remains limited.

“More than 40 million people in the US are living with diabetes, so a creative and collaborative approach is needed to ensure that people can access the tools that will help them successfully manage their condition,” lead author Jovan Milosavljevic, MD, MS, endocrinologist and assistant professor of medicine at Montefiore Einstein, said in the accompanying announcement.

The retrospective cohort study included adults aged 18 years and older with any insulin-treated diabetes who had at least 1 primary care visit between August 1, 2022, and August 1, 2025. Patients were excluded if they were uninsured, had a CGM prescription in the prior 2 years, or had their first CGM during follow-up prescribed outside primary care.

The study population was racially and ethnically diverse: 45.9% of patients were Hispanic, 35.0% were non-Hispanic Black, 4.8% were non-Hispanic White, and 10.6% were classified as other race or ethnicity. Medicare covered 42.6% of patients, and Medicaid covered 33.6%.

At baseline, patients prescribed CGM had higher mean HbA1c levels than noninitiators, at 9.5% vs 7.9%, and more often had HbA1c levels greater than 9.0%, at 50.8% vs 24.7%. They also had higher rates of several diabetes-related complications, including nephropathy, neuropathy, and retinopathy.

During follow-up, glycemic improvements appeared early and persisted. At 6 months, HbA1c decreased by 0.73 percentage points among CGM initiators vs 0.23 percentage points among noninitiators. At 24 months, the between-group difference remained similar, at –0.54 percentage points.

Importantly, patients whose diabetes care was managed exclusively in primary care also appeared to benefit. In this subgroup, the 12-month between-group HbA1c difference was –0.42 percentage points. These patients also had lower risks of hospitalization (HR, 0.81; 95% CI, 0.71-0.93) and ED visits (HR, 0.79; 95% CI, 0.71-0.89).

“People live with diabetes all day, every day, but when we were seeing these individuals in our clinics, we would just get one number, representing one moment in time,” Sybil J. Hodgson, MD, assistant vice president of clinical services at Montefiore Medical Group, said in the announcement.

For primary care clinicians, the findings support CGM implementation as a scalable strategy for insulin-treated patients, particularly in safety-net settings and populations with limited access to specialty care. Still, the study was observational, and exposure was defined by CGM prescription rather than confirmed device use. The authors noted that unmeasured confounding and events outside the health system may have affected results.

Investigators concluded that primary care–initiated CGM was associated with meaningful HbA1c improvements and fewer acute care events, supporting broader integration of CGM into routine primary care diabetes management.

References

1. Milosavljevic J, Rasquin Leon L, Rikin S, Schechter C, Hodgson S, Agarwal S. Primary care–initiated continuous glucose monitoring in adults with insulin-treated diabetes. JAMA Netw Open. 2026;9(7). doi:10.1001/jamanetworkopen.2026.21713
2. Montefiore Einstein. Continuous glucose monitors in primary care linked to better diabetes outcomes. Published July 2026.