MADRID — The use of continuous glucose monitoring (CGM) has reduced the risk of hospitalization and improved blood sugar control in people with diabetes. Type 2 diabetesregardless of Insulin New analysis of real-world data sheds light on its use.
The data will be presented at the European Association for the Study of Diabetes (EASD) 2024 Annual Meeting. Simultaneous release in Diabetes, Obesity, and MetabolismHospitalization and A1c The results were presented separately at EASD by two researchers, Satish K. Garg, MD, professor of medicine and director of the Adult Diabetes Program at the Barbara Davis Center at the University of Colorado in Aurora, Colorado, and Richard M. Bergenstal, MD, executive director of the International Diabetes Center at HealthPartners Research Institute in Minneapolis.
The advantages of CGM are: Type 1 diabetes People with type 2 diabetes who need multiple insulin doses each day, Hypoglycemia (such as those using sulfonylureas). In the U.S., Medicare and other insurance payers typically cover devices for these groups, but not for non-diabetics. Data on the impact of CGM use for diabetics who do not use insulin and are not at increased risk of hypoglycemia are limited to studies with small samples. In contrast, the new study used de-identified Market Clarity data from Optum on more than 79 million people, the authors note in the paper.
Overall, there were similar reductions in hospitalizations and blood glucose lowering effects with CGM in people not using insulin, people using only basal insulin, and people taking multiple daily insulin doses. “CGM is one of those treatments that can prevent people from being hospitalized and improve their overall care. The data is very strong,” Garg said. Medscape Medical News In an interview.
Bergenstal noted that CGMs can help people understand how diet and exercise affect blood sugar levels and then act on that information. “Lifestyle changes are important and they really do make a difference. It's very hard, but with a CGM, people can make the change.”
Reached for comment, Charles Alexander, M.D., an endocrinologist who previously worked for Merck and now serves as a medical and scientific advisor to Diatribe, said: Medscape Medical News“I think this really shows the value of CGM regardless of what you're using to treat your blood sugar. You might think that people who aren't using insulin wouldn't need a CGM, but these data really show the benefits regardless of whether you're taking pre-meal insulin, basal insulin, or using non-insulin medications.”
The benefit for non-insulin users likely has several mechanisms, Alexander says: “If you're taking a sulfonylurea, it could be that you avoid hypoglycemia. If you're not taking a sulfonylurea or a drug that causes hypoglycemia, it could have to do with the fact that you recognize when your blood sugar is too high and can do something about it… The biggest problem with A1c is that you don't know what your A1c is now, you only know what it was before, so you can't act on it. That's the value of a CGM – you can get an immediate understanding of what your blood sugar is.”
Real-world data shows reductions in hospitalizations and A1c across all treatment arms
The study included 74,679 people with type 2 diabetes who started CGM and were divided into three treatment groups: There were 16,264 people who used insulin, 16,264 people who used basal insulin only, and 33,146 people who used prandial and basal insulin. These data were analyzed over the 6 months before and 12 months after the first CGM claim.
Garg presented hospitalization data. In the six months prior to CGM implementation, there were 14,147 all-cause hospitalizations. This number dropped significantly at both time points, by 23.1% at six months and 18.8% at 12 months. Hypoglycemia, hypoglycemic coma, clinical hyperglycemia, Diabetic ketoacidosishyperosmolality was reduced by 52.5% and 49.5%, respectively, at the two time points. Acute diabetes-related events requiring emergency room visits were also reduced by 35.5% and 34.4%, respectively.
These reductions were similar across treatment groups. At 12 months, non-insulin-treated patients had a 10.1% reduction in all-cause hospitalizations (P < .0001), and 13.9% lower in patients receiving basal insulin therapy (P < .0001), and 22.6% lower in the mealtime insulin group (P = .0025). The reduction in acute diabetes-related hospitalizations at 12 months was even greater, at 31.0% (P < .0001), 47.6% (P < .0001), 52.7% (P < .0001, respectively.
There was a 30.7% reduction in acute diabetes-related events requiring emergency room visits at 12 months (P < .0001), 28.2% (P < .0001), 36.6% (P Each of the three treatment groups had a significantly higher mortality rate (< .0001).
Bergensthal presented a subgroup analysis of 6,030 people who had at least one A1c measurement before CGM use and at 6 and 12 months of CGM use. Baseline A1c levels were 8.6% in 1,533 people not taking insulin, 9.0% in 1,375 people taking basal insulin, and 8.9% in 3,122 people taking multiple daily insulin doses. By 12 months, these levels had fallen to 7.5%, 7.9%, and 8.0%, respectively. All three changes were statistically significant. P < .0001.
Overall, 23.4% achieved an A1c <7.0%, with the highest rate at 32.0% in the non-insulin-treated group.
Will wider use of CGMs reduce costs?
In their paper, Garg, Bergenstal and colleagues cited data showing that the per capita costs associated with hospital stays for people with diabetes are five times higher than those without diabetes ($5,668 vs. $1,138).
Bergensthal said in his presentation that the team plans to release more data soon to help with the cost analysis, and he noted that once all the data is publicly available, the American Diabetes Association will likely take it into account in its next diabetes standards of care, which could have an impact. Compensation decision.
“From a health economics perspective… [the upcoming data] We will show that CGM can save costs by reducing hospitalizations…The more data we can generate that shows the value of CGM, the more clearly insurers will be willing to pay for it.”
Mr. Garg sits on advisory boards for, and receives consulting fees and research grants from, Medtronic, Novo Nordisk, Roche Diagnostics, Know Labs, Eli Lilly, Dalio, Diasome, and Dexcom. He does not own stock in any medical device or pharmaceutical companies. Mr. Bergenstal has not disclosed any personal assets. His employer has contracted him for services and he has not received personal income from participation in clinical studies, scientific committees, or consulting for Abbott Diabetes Care, Ascensia, Bigfoot Biomedical, Secur, Dexcom, Eli Lilly, Embector, Hygeia, Insuret, Medtronic, NCQA, Novo Nordisk, Onduo, Roche Diabetes Care, Sanofi, UnitedHealthcare, Vertex Pharmaceuticals, or Zealand Pharma. Mr. Alexander has no disclosures.
Miriam E. Tucker is a freelance journalist based in the Washington, DC area. She is a regular contributor to Medscape Medical News and has also written for The Washington Post, NPR's Shots blog, and diaTribe. Follow her at @MiriamETucker.