Clinical Outcomes
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.
Learn MoreThis video reviews recent findings on the use of CGM. The studies highlight real world evidence supporting the broader use and
benefit of CGM at the patient and population level. Key takeaways include:
- The use of CGM has demonstrated clinical utility in non-intensively treated type two diabetes, including individuals using
non-insulin agents - CGM has shown an A1c reduction across diverse population who have historically experienced disparities in access to CGM
- CGM has demonstrated a clinical value in individuals also utilizing GLP1
- CGM is linked to reduced mortality in people with type one and type two diabetes using insulin
Among 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.
Learn MoreThe ADA Standards of Care include all of of the organization’s current clinical practice recommendations and are intended to provide clinicians, patients, researchers, payers, and others stakeholders with best practices in diabetes management, general treatment goals, and tools to evaluate the quality of care. The recommendations are based on an extensive review of the clinical diabetes literature, supplemented with input from ADA staff and the medical community at large. These comprehensive guidelines are updated annually, or more frequently online if new evidence or regulatory changes merit immediate incorporation In alignment with previous versions of the ADA Standards of Care, the 2024 update highlights the clinical benefit of CGM across a wide range of patient types based on a growing body of evidence.
Learn More