Strategy and results of the massive implementation of reimbursed continuous glucose monitoring in people with type 1 diabetes

Background and Aims: Widespread use of continuous glucose monitoring (CGM) in Type 1 Diabetes (T1D) under nationwide reimbursement, has shown an improvement in glucometrics, acute complications and patient satisfaction. Following the last phase of the reimbursement program for CGM in Catalonia (Spain), the feasibility and effectiveness of a decision tree algorithm addressed to its massive implementation was evaluated during COVID-19 pandemic. Methods: A straightforward decision tree algorithm was developed to systematically detect and categorize T1D patients from our Diabetes Unit. An administrative assistant, supported by healthcare-staff, contacted candidates and enrolled them into the program if willing to and according to: previous self-financing and digital skills. New users received information about the device, a contact number and 5 training webinars links. Patients unfamiliar with technology received a face-to-face education program. Results: Over a 3-month period, 1519 candidates were contacted by phone (52% women, mean age 43.82±15.29 years, mean HbA1c 7.71%±1.19, 19% of them were pump users). 320 (21%) self-financed CGM previously, 1045 patients (69%) initiated reimbursed CGM use, 331 (22%) declined the use of the device and we could not get in touch with 143 (9%) of patients. 292 patients (29%) joined the Diabetes educator-led webinars, while only 39 (3%) required face-to-face training. No major acute complication or relevant clinical issues were reported. Conclusions: Massive implementation of reimbursed CGMin T1D population in a short period of time is feasible, effective and safe using coordinated strategies between healthcare and nonhealthcare professionals including on-site, virtual visits and a web-site education package.