Use of rtCGM by patients with T1DM is associated with lower health care costs, fewer hospital admissions, and better glycemic control.

Context Health inequity is often associated with race-ethnicity. Objective To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with Type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users to non-users. Design The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared to non-users by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist. Setting Community Patients or Other Participants Beneficiaries with T1D and at least one inpatient or two outpatient claims in a CY Intervention(s) Pump or CGM therapy, visit to an endocrinologist Main Outcome Measure(s) Diabetes-related technology use by race-ethnicity groups Results Between 2017 and 2019 CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was <5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019 57% of White patients used a pump compared to 33.1% of Black and 30.3% of Other patients (P<0.001). Black patients were more likely than White patients to be eligible due to disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P<0.001), whether using technology or not. Significant race-ethnicity differences (P<0.001) existed between technology users and non-users for all evaluated factors except visiting an endocrinologist. Conclusions Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.

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DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2-9% regardless of insurance type.

A245 objectives. Adult patients with type 2 diabetes mellitus (T2DM) newly initiating treatment between January 1, 2010, and December 31, 2011, with either saxagliptin or sitagliptin were identified. A 1:1 propensity-matched sample of saxagliptin and sitagliptin patients was created to reduce any potential confounding. Propensity scores were generated based on demographic characteristics, comorbidities, disease severity and treatment patterns before the index date. Patients were required to have ≥ 6 months of continuous eligibility before (baseline period) and after (followup period) treatment initiation. All outcomes were assessed based on an intent-totreat analysis in the 6-month follow-up period. Both overall and diabetes-specific charges were computed; breakdowns of medical and overall (medical plus pharmacy) charges were compared. Appropriate univariate statistical tests were applied to the propensity-matched sample to examine differences in resource utilization outcomes. Results: A total of 8,438 and 23,155 patients initiated treatment with saxagliptin and sitagliptin, respectively. After matching, each cohort consisted of 7,700 patients. Compared with sitagliptin, during the follow-up period, saxagliptin was associated with significantly lower (all p values ≤ 0.