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A 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.
Learn MoreClinical practice guidelines endorse the use of CGM, and CMS recently expanded coverage for this technological intervention. However, disparities due to racial/ethnic bias, insurance coverage, and healthcare literacy present barriers to equitable diabetes care and access to CGM. Data show that members of minority populations, those with lower socioeconomic status and those without private insurance are disproportionately affected by diabetes and have lower rates of CGM use. This article, published in Managed Healthcare Executive, notes that payers should place greater emphasis on expanding patient education programs. In addition, further action must be taken to inform patients and to increase adoption and dissemination of new diabetes care technology. In addition to enhancing provider knowledge of CGM and its role in optimal patient care, managed care and payer professionals are tasked with ensuring that unnecessary barriers do not exist in current coverage policies.
In an accompanying video series, Estay Greene, PharmD, MBA, provides insights on ways to improve the care of patients with diabetes from the payer persepective, with a focus on data supporting the use of CGM. Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, FADCES, FCCP, and David Hines also share their perspectives on social determinants of health in diabetes management and overcoming disparities in care with appropriate use of CGM.
Learn MoreThis article provides a comprehensive summary of the latest discoveries in the category of continuous glucose monitoring (CGM). It compiles the most recent scientific findings in an easy-to-read format, complete with hyperlinks and QR codes to full-text articles and abstracts. Read here to learn how increased implementation and expanded access to CGM may improve clinical and economic outcomes and reduce diabetes-related healthcare utilization and costs.
Key Topics:
- 2024 Clinical Practice Updates and Quality Measure Changes
- Emerging Evidence for CGM Use in Non-Intensively Treated Type 2 Diabetes
- Reduction in Healthcare Resource Utilization and Mortality
- Real-World Data Showing CGM Reduces Costs
- Utilization of GLP-1 Agonists in Conjunction with CGM
A poster presented at the Academy of Managed Care Pharmacy’s (AMCP) annual meeting in New Orleans, LA, shared data from a health initiative by Metro Nashville Public Schools. The employer provided CGM devices as a pharmacy benefit without prior authorization. This policy change led to a two-fold increase in CGM utilization among employees aged 18 to 64 years with T1D and T2D regardless of treatment regimen. The retrospective analysis, covering 184 participants, showed significant improvements in glycemic control associated with CGM use. Specifically, average A1c decreased from 8.7% to 7.9% and from 7.6% to 6.8% among those with T2D treated with insulin and not-treated with insulin, respectively. Additionally, CGM use resulted in a significant improvement in the proportion of individuals meeting the HEDIS and ADA HbA1c targets of <8.0% and <7.0%, respectively. These results underscore the potential benefits of CGM for improving diabetes management through streamlined health care payer and purchaser coverage.
Learn MoreThe poster outlines best practices for health plan coverage and access to Continuous Glucose Monitoring (CGM) for diabetes management, emphasizing the technology’s transformative impact on care. It recommends aligning coverage criteria with current medical evidence, enhancing utilization oversight, and improving access for underserved populations. Strategies include offering CGM under pharmacy benefits, educating healthcare providers and patients, and developing support systems for at-risk groups. The best practices, derived from expert interviews, a national survey, and a workshop, aim to assist health plan decision makers in optimizing diabetes outcomes and managing healthcare costs efficiently.
Learn MoreAmong 47 patients enrolled in a cardiovascular disease (CVD) outpatient program, CGM use was associated with improved glycemic and cardiometabolic outcomes. In the two-phase crossover study, participants were required to have T2D not treated with insulin therapy, an HbA1c >7%, and an obesity classification (BMI ≥30 kg/m2). Through 90 days of follow-up, CGM use was associated with a reduction in average glucose (184.0 to 147.2 mg/dL, P<0.001), an increase in time in range (57.8 to 82.8%, P<0.001), and a trend towards lower glycemic variability (26.2% to 23.8%). CGM users also experienced significant reductions in HbA1c, body mass index (BMI), triglycerides, blood pressure, total cholesterol, diabetes distress, and 10-year predicted risk for atherosclerotic cardiovascular disease (P<0.05 for all). These findings are pertinent to managed care and payer professionals seeking to better manage outcomes in T2D with comorbid CVD in health plan populations.
Reed J, Dong T, Eaton E, Friswold J, Porges J, Al-Kindi SG, Rajagopalan S, Neeland IJ. Continuous glucose monitoring for glycaemic control and cardiovascular risk reduction in patients with type 2 diabetes not on insulin therapy: A clinical trial. Diabetes Obes Metab. 2024 Apr 28. doi: 10.1111/dom.15608. Epub ahead of print.
Learn MoreIn a real-word study analyzing 12 months of pre- and post-CGM-initiation US claims data, researchers found that CGM utilization was associated with lower hospital use and diabetes-related costs in intensive insulin-treated T2D. Among the 790 individuals who met the inclusion criteria, the number with ≥1 ED visit decreased by 30.0% (P=0.01) and with ≥1 inpatient visit decreased by 41.5% (P<0.0001). The number of diabetes-related visits and average number of visits per person likewise decreased by at least 31.4%. Total diabetes-related costs expressed as per-person-per-month (PPPM) also decreased by $341 PPPM. Managed care and payer professionals will find this analysis of interest in assessing the value of CGM as a cost-reduction intervention in the management of T2D among plan members.
Hannah KL, Nemlekar PM, Green CR, Norman GJ. Reduction in Diabetes-Related Hospitalizations and Medical Costs After Dexcom G6 Continuous Glucose Monitor Initiation in People with Type 2 Diabetes Using Intensive Insulin Therapy. Adv Ther. 2024 Apr 15. doi: 10.1007/s12325-024-02851-8. Epub ahead of print. PMID: 38619722.
Learn MoreA retrospective cohort study published in JAMA Network Open showed that CGM use was associated with lower odds of developing diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR). Among 550 adults with type 1 diabetes (T1D) included in the analysis, 62.7% patients used CGM, 58.2% used an insulin pump, and 47.5% used both. After adjusting for age, sex, race and ethnicity, diabetes duration, microvascular and macrovascular complications, insurance type, and mean HbA1c, CGM was associated with lower odds of DR (odds ratio [OR], 0.52; 95% CI, 0.32-0.84; P=0.008) and PDR (OR, 0.42; 95% CI, 0.23-0.75; P =0.004), compared with no CGM use. These findings show that CGM can be beneficial preventing DR—the leading cause of blindness among adults in the United States—even in individuals with well managed T1D.
Liu TYA, Shpigel J, Khan F, Smith K, Prichett L, Channa R, Kanbour S, Jones M, Abusamaan MS, Sidhaye A, Mathioudakis N, Wolf RM. Use of Diabetes Technologies and Retinopathy in Adults With Type 1 Diabetes. JAMA Netw Open. 2024 Mar 4;7(3):e240728.
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Leveraging an opportunity for health plans to support improved patient outcomes in diabetes management with CGM, AMCP sponsored a multifaceted initiative to identify best practices. The program approach consisted of expert interviews, a national payer survey, and an expert panel workshop with clinical experts and managed care stakeholders. In addition to a national webcast to communicate the program findings, this supplement published in the Journal of Managed Care and Specialty Pharmacy summarizes current evidence and consensus recommendations for CGM to support the effective management of diabetes in health plan populations. The supplement also presents the findings from the national payer survey and describes expert-supported health plan best practices around streamlined but evidence-based coverage and access to CGM. Managed care and payer professionals will find this information useful in making collaborative, evidence-based decisions to optimize outcomes among members with diabetes.
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