Author: Julia Vetsikas
Among semaglutide users with T2D, use of CGM was associated with greater decreases in A1c compared to non-CGM users, regardless of insulin therapy. Reductions in A1c were greater for CGM users (-0.85%) compared to the control group (-0.29%) in the overall cohort (differences-in-differences (DID), -0.55%, P<0.0001). The proportion of CGM and semaglutide users who met the ADA target of A1c <7% nearly doubled compared to baseline. The proportion of CGM and semaglutide users who met the HEDIS target of A1c <8% increased by more than 50% compared to 12% for non-CGM users. These results suggest an additive effect of CGM and semaglutide, and their combined use could help more people with T2D reach their glycemic targets. The possible mechanisms underlying the additive benefit between CGM and semaglutide could include improved diabetes management self-efficacy (related to diet, exercise, and medication adherence) and more effective medication titration. CGM may enhance patient understanding and management of T2D, including those on GLP-1s.
Learn MoreCGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn MoreAn expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreThe Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
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In a recent cross-sectional study of electronic health record data, researchers found low rates of CGM prescription orders among Federally Qualified Health Center patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). A total of 1,168 patients with T1D and 35,216 patients with T2D were included. Overall, CGM prescriptions were infrequent, with 11.0% of patients with T1D and 1.0% of patients with T2D receiving a prescription. Disparities in CGM orders were also observed among patients reporting Hispanic ethnicity, Black race, and those who lacked health insurance. Specifically, patients with T1D or T2D who reported Hispanic ethnicity, Black race, or were uninsured had lower multivariable odds of receiving a CGM prescription than White or insured adults (odds ratio [OR], 0.30-0.76). Among patients with T2D, HbA1c values >9.0% (OR, 3.17; 95% CI, 2.37-4.21) and a greater burden of diabetes complications were associated with higher odds of CGM prescription. These findings are of particular interest to managed care and payer stakeholders seeking to identify and address the impact of social determinants of health in vulnerable patient populations.
Wallia A, Agarwal S, Owen AL, et al. Disparities in Continuous Glucose Monitoring Among Patients Receiving Care in Federally Qualified Health Centers. JAMA Netw Open. 2024;7(11):e2445316.
Learn MoreThe recently issued 2025 ADA Standards of Care offered new guidance supporting CGM use in broader patient populations, the application of CGM metrics in achieving glycemic goals, and the integration of CGM with other diabetes technologies at diagnosis. Specifically, the 2025 Standards of Care recommend considering the use of CGM in adults with T2D NIT to achieve and maintain individualized glycemic goals. Reasserting the clinical value of CGM in type 1 diabetes in pregnancy, the ADA added that CGM may also be beneficial for gestational diabetes and T2D in pregnancy in the 2025 update. ADA also expanded their recommendation for CGM use in individuals with diabetes on any insulin therapy to include youths as well as adults. While previous versions of the Standards of Care stated that CGM metrics should not be used as a substitute for BGM, the 2025 update notes that CGM metrics can be used in conjunction with blood glucose monitoring to achieve glycemic goals. Highlighting the importance of early intervention, the ADA also recommends initiation of CGM, continuous subcutaneous insulin infusion, and automated insulin delivery at diagnosis, depending on a person’s or caregiver’s needs and preferences. These updates are relevant to managed care and payer decision makers in the development of clinically appropriate coverage policies that enhance access to CGM in broader patient populations.
American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S6-S13.
Learn MoreAs many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
This interactive infographic highlights the clinical and economic value of CGM in the management of type 1 and type 2 diabetes (T1D and T2D) regardless of treatment regimen. The studies featured have been published in peer-reviewed journals and presented at the 84th American Diabetes Association (ADA) Scientific Sessions. Key areas of focus pertinent to payer professionals include long-term glycemic control in T2D, HbA1c reduction in managed care, improved T2D outcomes in the community setting, cost-effectiveness in T2D, and reduced hospitalizations in T2D. Collectively, this evidence demonstrates that appropriate coverage and utilization of CGM can improve clinical outcomes and reduce diabetes-related healthcare resource utilization. Summarizing the findings in a useful format, the infographic offers key takeaways for managed care and payer professionals associated with each individual study featured.
Learn MoreA retrospective observational study using Aetna administrative claims data showed that CGM use was associated with clinically meaningful improvements in A1c and reduced health care resource utilization. The study, published in the Journal of Managed Care and Specialty Pharmacy, looked at a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and coverage for medical and pharmacy benefits. Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) showed a significant improvement in A1c after CGM initiation (-0.7%, P<0.0001), including a -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (P<0.0001 for both). This real-world analysis suggests a potential for population-level clinical and economic benefits with CGM in a managed care setting, particularly among patients not using insulin.
Learn MoreA retrospective claims analysis of 74,679 adults with T2D showed significant reductions in all-cause hospitalizations, acute diabetes-related hospitalizations, and acute diabetes-related emergency room visits associated with CGM use. These sizeable reductions in health care resource utilization were observed in patients treated with non-insulin therapy (NIT; -10.1%, -31.0%, -30.7%), basal insulin therapy (BIT; -13.9%, -47.6%, -28.2%), and prandial insulin therapy (PIT; -22.6%, -52.7%, -36.6%, respectively) across the 6 to 12 month post-index period. Mean HbA1c was likewise reduced across all treatment types at approximately 3 months and sustained throughout the post-index period (NIT, -1.1%; BIT, -1.1%; and PIT, -0.9%; P< 0.0001).Study authors noted that these findings support expanded coverage of CGM use for people with T2D regardless of treatment type to improve glycemic control and reduce hospitalizations and overall health care costs. Furthermore, the study suggests that managed care and payer decision makers can benefit from consideration of CGM use in patients with T2D who are often ineligible for coverage as a means of managing the total cost of care.
Garg SK, Hirsch IB, Repetto E, Snell-Bergeon J, Ulmer B, Perkins C, Bergenstal RM. Impact of continuous glucose monitoring on hospitalizations and glucose control in people with type 2 diabetes: real-world analysis. Diabetes Obes Metab. September 12, 2024. doi: 10.1111/dom.15866. Epub ahead of print.
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