Continuous glucose monitoring and health equity: Reaching those in need

Clinicians and healthcare industry analysts say that continuous glucose monitoring systems are valuable tools in helping patients manage diabetes, and they’re enthusiastic to see them adopted more widely.

Ashraf Shehata of KPMG says health equity is an important consideration as providers look to expand the use of glucose monitoring systems.

But at a time when there’s growing attention and concern about closing gaps in care for disadvantaged communities, healthcare leaders say it’s important to ensure that the devices are going to individuals even if they have lower incomes.

Ashraf Shehata, KPMG’s U.S. sector leader for healthcare, tells Chief Healthcare Executive® that he’s confident the market for continuous glucose monitoring systems is poised for continued growth. Shehata also says that he hopes that providers think about ensuring access to all patients.

“There's potentially a lot of inequities around the distribution of these devices,” Shehata says.

“Some of the most vulnerable populations usually have the highest incidence of diabetes and require the most consistent management of the disease,” he says. “So I think that's the other piece of it too, that there's going to be a more and more greater focus on accessing the device in the most vulnerable populations.”

Those with lower incomes saw greater spikes in diabetes cases than more affluent Americans, according to a 2021 study by the Centers for Disease Control and Prevention.

Even with the growing popularity of diabetes medications, so-called GLP-1 drugs, Shehata says continuous glucose monitoring systems will remain useful tools for patients.

“They still have to monitor and measure and I think that's going to be really important,” Shehata says.

State Medicaid programs will need to look at how to best ensure that patients have access to continuous glucose monitoring systems, as well as affordable insulin and access to healthy foods, Shehata says.

• Read more: Using continuous glucose monitoring devices to help patients manage their diabetes

Dr. Robert McCauley, chief of endocrinology at Lehigh Valley Health Network, says providers that are hoping to expand use of continuous glucose monitoring will also have to consider social factors affecting the health of their patients, including their diet and access to transportation.

“So many different aspects of life impacts your diabetes control,” McCauley says.

At Sutter Health, a California health system operating 22 hospitals, researchers and clinicians have been exploring ways to improve access to digital tools to help patients with diabetes.

Dr. David Kerr, a senior scientist at Sutter’s Center for Health Systems Research and Dr. David Klonoff, medical director of the Diabetes Research Institute at Sutter’s Mills-Peninsula Medical Center, led a study on closing disparities for patients with diabetes. They published their findings in Endocrine Practice and made the case for a “connected diabetes ecosystem.”

They stressed the need for enabling patients with lower incomes to utilize continuous glucose monitoring systems and other tools to help them manage their diabetes.“A connected diabetes ecosystem should incorporate and optimize the use of existing treatments and technologies, integrate tasks such as glucose monitoring, data analysis, and insulin dose calculations, and lead to improved and equitable health outcomes,” the authors wrote.

• Read more: Improving patient care for patients with diabetes

Researchers looking at the use of continuous glucose monitoring systems in New Zealand found disparities in access among different communities, according to findings published in November 2023 in The Lancet Regional Health-Western Pacific. The authors wrote that pediatricians and pediatric endocrinologists must not be “gatekeepers to diabetes technologies.”

Still, researchers point out that continuous glucose monitoring systems and other digital tools offer great promise in expanding care for those with diabetes and helping them avoid more serious complications and possibly hospitalization. And they offer optimism that they could help close disparities in outcomes, provided sufficient access.

In the Endocrine Practice study, researchers offered a hopeful note about the promise of a more connected system to help patients, particularly in light of a physician shortage that could worsen over time.

“There remain many hurdles to overcome and questions to be answered before a connected digital diabetes ecosystem can be developed,” the researchers wrote. “An integrated system would personalize and optimize the performance of already existing technologies and treatments to improve outcomes for their users. It would also help to overcome health inequities, providing more widespread access to technology, support, and knowledge.

“If these are achieved, then a connected ecosystem has the potential to reduce the burden of diabetes care on patients, HCPs, and health care systems.”

• Read more: Diabetes research is filled with great promise