Initiation of Continuous Glucose Monitoring Is Linked to Improved Glycemic Control and Fewer Clinical Events in Type 1 and Type 2 Diabetes in the Veterans Health Administration

Abstract

OBJECTIVE To determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events. RESEARCH DESIGN AND METHODS A retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months. RESULTS CGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (−0.26%; 95% CI −0.33, −0.19%) and T2D (−0.35%; 95% CI −0.40, −0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c <8 and <9% after 12 months were greater in CGM users. In T1D, CGM initiation was associated with significantly reduced risk of hypoglycemia (hazard ratio [HR] 0.69; 95% CI 0.48, 0.98) and all-cause hospitalization (HR 0.75; 95% CI 0.63, 0.90). In patients with T2D, there was a reduction in risk of hyperglycemia in CGM users (HR 0.87; 95% CI 0.77, 0.99) and all-cause hospitalization (HR 0.89; 95% CI 0.83, 0.97). Several subgroups (based on baseline age, HbA1c, hypoglycemic risk, or follow-up CGM use) had even greater responses. CONCLUSIONS In a large national cohort, initiation of CGM was associated with sustained improvement in HbA1c in patients with later-onset T1D and patients with T2D using insulin. This was accompanied by a clear pattern of reduced risk of admission to an emergency room or hospital for hypoglycemia or hyperglycemia and of all-cause hospitalization.

An Analysis of the Distribution of Direct Cost of Diabetes Care in Selected Districts in Italy

“…The RELIEF study has also confirmed that the use of scanning CGM in people with T2D on basal insulin treatment is also associated with significantly reduced rates of hospital admission for DKA and severe hypoglycemia, for at least 2 years after initiation of scanning CGM [ 20 ]. Other studies have shown that using scanning CGM compared to SMBG is associated with a 25–40% reduction in all-cause hospital admissions for people with T1D [ 25 , 26 ] and a 11–15% reduction in all-cause admissions for people with T2D treated with insulin [ 25 , 27 ]. Given that the costs of hospitalization can be as high as €4835 for each person with diabetes and significant comorbid disease in Italy (Table 5 , Supplementary Table S1 ), such reductions in hospital admission can be substantial.…”

Association Between Adherence, A1C Improvement, and Type of Continuous Glucose Monitoring System in People with Type 1 Diabetes or Type 2 Diabetes Treated with Intensive Insulin Therapy

“…This lower adherence among isCGM users compared to rtCGM users is notable because CGM use is associated with reductions in A1C and a lower risk of acute and long-term diabetes complications [ 3 , 4 , 16 – 19 ]. It is unknown whether people using insulin who stopped using CGM returned to self-monitoring of blood glucose (SMBG) regimens or administered insulin with little to no information about their glucose levels.…”

Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?

“…Multiple clinical trials and real-world evidence studies of CGM have demonstrated improvement in glycaemic control, acute care use, and quality-of-life outcomes for adults with T2D. [79][80][81][82] Furthermore, in a recent study of intermittent short-term use of real-time CGM, this appears to be an effective method for glucose control in adults with T2D treated with oral agents, especially when combined with traditional self-monitoring of blood glucose. 83 CGM use in adults with T2D is now recommended within authoritative clinical guidelines.…”