Continuous Glucose Monitoring Use in Type 1 Diabetes: Longitudinal Analysis Demonstrates Meaningful Improvements in HbA1c and Reductions in Health Care Utilization

Abstract

Background: Real-time continuous glucose monitoring (rtCGM) improves glycemic control in type 1 diabetes (T1D) patients treated with continuous subcutaneous insulin infusion (CSII). However, the benefits of rtCGM in T1D patients treated with multiple daily insulin injection (MDI) therapy has not been well studied. We explored the effects of rtCGM versus self-monitoring of blood glucose (SMBG) on clinical outcomes within a large T1D population treated with either CSII or MDI therapy. Methods: This retrospective, longitudinal analysis utilized datasets from T1D patients enrolled in a commercial health plan to assess changes in HbA1c in 187 naïve to rtCGM users and 6260 SMBG users. Propensity score modeling was used to assess inpatient admissions, emergency room (ER) visits in 1130 patients (565 rtCGM, 565 SMBG). Differences in HbA1c reduction (rtCGM+MDI vs rtCGM+CSII) were evaluated. Results: Larger, clinically meaningful HbA1c reductions were seen among rtCGM versus SMBG users: –0.5% (P = .004) versus −0.2% (P < .0001); 0.3% diff in diff, P = .03. All-cause inpatient admissions were lower for rtCGM users: –42%, P = .013. Emergency room visits coded for diabetic ketoacidosis (DKA) were four times higher for SMBG patients than rtCGM patients: 17 versus 4, P = .0318. HbA1c reductions were most notable with rtCGM+MDI versus rtCGM+CSII treatment: –0.6% (P = .01) versus −0.3% (P = .16). Conclusions: Use of rtCGM in T1D patients facilitates greater HbA1c improvements and reduced health care system utilization compared with traditional SMBG use regardless of insulin administration method. Treatment with rtCGM in conjunction with MDI confers similar or greater glycemic benefits without the additional costs associated with CSII therapy.

First assessment of the performance of an implantable continuous glucose monitoring system through 180 days in a primarily adolescent population with type 1 diabetes

“…In contrast to the documented benefits of CGM use in adult patients with diabetes, studies specifically involving paediatric patients have shown more inconsistent findings . This disparity in benefits may be partly as a result of even more inconsistent use than that observed in adults.…”

“…One of the key barriers to long-term adoption of CGM technology has been tiredness of use, with patients reporting discontinuation in the first year because of many reasons including perceived inaccuracy (53%), wear discomfort (47%), insertion pain (31%) and skin irritation (41%). 2 In contrast to the documented benefits of CGM use in adult patients with diabetes, 3,4 studies specifically involving paediatric patients have shown more inconsistent findings. 5 This disparity in benefits may be partly as a result of even more inconsistent use than that observed in adults.…”

Continuous Glucose Monitoring: A Review of Recent Studies Demonstrating Improved Glycemic Outcomes

“…The cost-effectiveness of CGM and closed-loop systems is considered in more detail elsewhere. [133][134][135] CGM also serves as a tool that can assist evaluation of new and improved methods for medical therapy of diabetes, for earlier detection of prediabetes, and earlier diagnosis of diabetes.…”

Wearable Continuous Glucose Monitoring Sensors: A Revolution in Diabetes Treatment

“…From a clinical point of view, the use of real-time CGM showed meaningful improvements in glycated hemoglobin (HbA1c) [45] and a reduction of hypoglycemic events [46]. Moreover, the use of CGM sensors was demonstrated to improve quality of life [47], e.g., by reducing fear of hypoglycemia [48], and resulted in being cost-effective in long-term projections [45].…”

“…From a clinical point of view, the use of real-time CGM showed meaningful improvements in glycated hemoglobin (HbA1c) [45] and a reduction of hypoglycemic events [46]. Moreover, the use of CGM sensors was demonstrated to improve quality of life [47], e.g., by reducing fear of hypoglycemia [48], and resulted in being cost-effective in long-term projections [45]. Although all these benefits have been extensively proven, there are still many other factors that influence patient and clinician confidence in the use of CGM, such as accuracy, reliability, usability, duration of sensor life, and calibration requirements [49].…”