Impact of a Nurse Practitioner-Led Diabetes Program on Barriers to CGM Use in a Federally Qualified Health Center After Medicaid Expansion.

Objective: Continuous glucose monitors (CGMs) enhance diabetes management, but disparities exist, particularly among underserved populations in federally qualified health centers (FQHCs). In 2022, a California Medicaid policy change expanded CGM coverage, providing an opportunity to better evaluate barriers to CGM use within primary care in an FQHC. Methods: We used 2022-2023 electronic health record (EHR) data to identify adults with diabetes managed on insulin within a nurse practitioner-led diabetes program in primary care. Patients were categorized as current, former, or never CGM users. We used summary statistics, chi-squared, and Bartlett's tests to assess unadjusted group differences and multivariate logistic regression to identify factors associated with former or never use. All patients were invited to complete a survey on CGM facilitators and barriers. Results: Among 275 eligible patients, 109 (40%) were current CGM users, 31 (11%) former users, and 135 (49%) never users. Discussions on CGM occurred in 45% of never users, who were more likely to have non-Medicaid insurance, fewer than five clinic visits (OR 3.69, 95% CI: 1.94-6.99), and a lower baseline A1C (OR 0.67, 95% CI: 0.52-0.86). No demographic or clinical factors were associated with former CGM use. Among survey respondents (n = 124), the desire to reduce finger-pricks motivated CGM use, while device burden and inconvenience contributed to discontinuation or refusal. Conclusions: Medicaid policy expansion reduced major structural barriers to CGM use, yet some patient-related barriers persisted. Team-based care models integrating health educators and advanced practice providers can successfully support CGM access and sustained use in underserved populations.