HLTH 4403 Module 4 Wearable Monitoring Device Assessment Example

Fourteen Days of Glucose Data on a Phone the Clinic Cannot See: Assessing Continuous Glucose Monitors for Adults With Type 2 Diabetes Who Do Not Use Insulin

Student Name

American College of Education

HLTH4403: Healthcare Information Management

Module 4 Assignment

Instructor Name

October 26, 2026

The Proposal

Clinicians at the composite community health center network examined in earlier modules have asked administration to offer continuous glucose monitors to adults with type 2 diabetes whose A1c remains above 9%, most of whom take oral medications and not insulin. A continuous glucose monitor is a small sensor worn on the back of the arm that measures glucose in the fluid beneath the skin every few minutes for up to two weeks, sending readings to a phone or reader. The request gained urgency when the Food and Drug Administration cleared the first over-the-counter continuous glucose monitor, intended for adults who do not use insulin, including people treating diabetes with oral medications (U.S. Food and Drug Administration, 2024). Patients have begun arriving with their own sensors and asking clinicians to look at the data.

This paper assesses whether the network should adopt continuous glucose monitoring for this group and, if so, which model of use fits its patients, its record and its staff.

What the Evidence Shows

The clinical case is real but modest. Jancev et al. (2024), in a meta-analysis of 12 randomized trials with 1,248 adults with type 2 diabetes, found that continuous glucose monitoring lowered A1c by an average of 0.31 percentage points compared with fingerstick self-monitoring. The effect was similar in trials of people using only oral agents, about 0.29 points, and monitoring also increased the time glucose stayed in the target range. Devices that send readings automatically showed a trend toward a larger effect than those the user must scan.

For patients whose A1c is above 9%, a reduction of three-tenths of a point will not by itself bring them to target. The value of the device lies in what patients and clinicians do with the readings: seeing the rise after a particular meal, or the effect of a walk, and adjusting treatment with data rather than a single quarterly number. That makes the information system around the device as important as the device itself.

Two Models of Use

The network could use the technology in two ways. In professional monitoring, the clinic places a sensor, the patient wears it for about 10 to 14 days, and the data are uploaded and reviewed at a follow-up visit, often with a diabetes educator. The clinic controls the device and the data, and the patient needs no smartphone. In personal monitoring, the patient owns the sensor, prescription or over-the-counter, and views readings continuously on a phone app, sharing them with the clinic if an account link is set up.

Personal monitoring offers continuous feedback, which is where the evidence of benefit is strongest, but it depends on coverage, a compatible phone and the patient's comfort with an app. Coverage for patients who do not use insulin remains limited in many plans, and over-the-counter sensors are paid for out of pocket, a real barrier for a population mostly on Medicaid or uninsured. Professional monitoring reaches patients the personal model would miss, at the cost of feedback that arrives after the wear period rather than in the moment.

Where the Data Live

The information problem is the one clinicians raised first. Continuous glucose data do not flow into the network's electronic health record. Each manufacturer keeps readings in its own cloud platform, and clinicians must log into a separate website for each brand to view a patient's report, then summarize it in a note by hand. A patient's two weeks of readings, several thousand values, become a sentence of free text, which repeats the problem found in the first module: information that exists but cannot be counted, trended or used by the registry.

The international consensus on time in range recommends standardized metrics and targets for interpreting these data, and for most adults with diabetes it sets the aim at over 70% of readings falling between 70 and 180 mg/dL, with under 4% dropping below 70 mg/dL (Battelino et al., 2019). If the network adopts the technology, those metrics should be entered as structured fields, time in range, time below range and mean glucose, so that they can be tracked like an A1c. A sensor that produces 4,000 readings the record cannot hold is, for the health system, a very expensive way to write one line in a note.

Access and Equity

The same patients who were least likely to use the portal are least likely to have a phone, plan and data allowance that support personal monitoring. At this network, a third of adults prefer Spanish, and app instructions and alerts may be available only in English for some devices. If the network adopts personal monitoring alone, it will likely reach the patients who were already easiest to engage. A professional model, with sensors placed in clinic and reviewed with an educator in the patient's language, reaches everyone who can come to two visits. It also lets the educator show a patient, on a printed report, exactly which breakfast drove the morning spike.

Privacy and Workload

When the clinic places and reads a professional sensor, the data are part of the patient's care and fall under the network's privacy practices. When a patient buys a sensor and uses the manufacturer's app, the readings are held under that company's terms, which may allow uses the patient has not considered. Clinicians should be able to explain the difference, and the network should review the data-sharing terms of any device it recommends. Workload also matters: reviewing a report takes 10 to 15 minutes, and without scheduled time for it, readings pile up unread in vendor portals. There is also a question of responsibility. Once a patient links a personal sensor to the clinic's account, the patient may assume someone is watching the readings between visits, when in fact no one is. The network must tell patients plainly, in both languages, that shared data are reviewed at scheduled visits only and are not monitored for emergencies, and the sign-up form should say the same thing. A low reading seen days later in a vendor portal is a safety event the clinic did not know it had taken on.

Assessment

The network should adopt continuous glucose monitoring for adults with type 2 diabetes and an A1c above 9%, starting with a professional model for 150 patients over six months, with each wear period followed by a visit with a diabetes educator. It should enter time in range, time below range and mean glucose as structured fields, and it should support patients who already have personal sensors by linking their accounts. Evaluation should compare A1c change, follow-up visits kept and staff time per patient against similar patients not offered sensors. If the professional model shows benefit and the data can be captured reliably, the network can move toward personal monitoring as coverage allows.

References

Battelino, T., Danne, T., Bergenstal, R. M., Amiel, S. A., Beck, R., Biester, T., Bosi, E., Buckingham, B. A., Cefalu, W. T., Close, K. L., Cobelli, C., Dassau, E., DeVries, J. H., Donaghue, K. C., Dovc, K., Doyle, F. J., Garg, S., Grunberger, G., Heller, S., ... Phillip, M. (2019). Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the international consensus on time in range. Diabetes Care, 42(8), 1593-1603. https://doi.org/10.2337/dci19-0028

Jancev, M., Vissers, T. A. C. M., Visseren, F. L. J., van Bon, A. C., Serné, E. H., DeVries, J. H., de Valk, H. W., & van Sloten, T. T. (2024). Continuous glucose monitoring in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetologia, 67(5), 798-810. https://doi.org/10.1007/s00125-024-06107-6

U.S. Food and Drug Administration. (2024, March 5). FDA clears first over-the-counter continuous glucose monitor [Press release]. https://www.fda.gov/news-events/press-announcements/fda-clears-first-over-counter-continuous-glucose-monitor