ORIGINAL RESEARCH
Sean M. Oser, MD, MPH; Tristen L. Hall, PhD, MPH; Kimberly Wiggins, MA, MEd; L. Miriam Dickinson, PhD; Mark Gritz, PhD; Stephanie Kirchner, MSPH, RD; Douglas H. Fernald, MA; Bonnie Jortberg, PhD, RD, CDCES; Chelsea Sobczak, MPH; Danika Buss, BA; Jessica Parascando, MPH; Kristin Crispe, MPH; W. Perry Dickinson, MD; Tamara K. Oser, MD
Corresponding Author: Tristen L. Hall, PhD, MPH; University of Colorado Anschutz Medical Campus, Department of Family Medicine.
Email: tristen.hall@cuanschutz.edu
DOI: 10.3122/jabfm.2025.250488R1
Keywords: Continuous Glucose Monitoring, Implementation Science, Online Education, Primary Health Care, Technology, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Wearable Technology
Dates: Submitted: 12/23/2025; Accepted: 04-13-2026
Status: In Press.
INTRODUCTION: An estimated 15.8% of U.S. adults have diagnosed or undiagnosed diabetes. Continuous glucose monitoring (CGM) is associated with improved clinical and behavioral outcomes for people with diabetes. Adoption of diabetes technologies has been slower in primary care than specialty settings, but CGM training and education could support expanded use and improved patient outcomes.
METHODS: We report practices’ number of CGM prescriptions and CGM implementation scores from a hybrid type 3 effectiveness-implementation study comparing three strategies for primary care CGM implementation: online education (TIPS), online education plus practice facilitation (TIPS + PF), and a virtual CGM initiation service (virCIS). Practices selected from online education or virtual initiation strategies; online education practices were randomized to TIPS or TIPS + PF. We describe changes over time (baseline, 6 months, 12 months) in practice-level outcomes using descriptive statistics and general linear mixed models.
RESULTS: Seventy primary care practices enrolled in the study, representing clinician- and independently-owned practices (51.4%), FQHCs or Rural Health Centers (28.6%), and hospital-owned practices (20.0%). All arms demonstrated significant increases in CGM prescribing (p<.001) and practice-level implementation scores (p<.001). TIPS + PF and virCIS practices demonstrated greater increases in CGM prescribing compared to TIPS-only practices (p=.02).
CONCLUSION: Primary care practices using implementation strategies including online educational modules with or without practice facilitation and a virtual CGM initiation service significantly increased CGM prescribing and CGM implementation scores over 12 months. Primary care practices should consider these strategies to improve diabetes care and management and expand access to diabetes technology.