Poorva M. Nemlekar

This study evaluated how real-time continuous glucose monitoring (RT-CGM) use was associated with medication use patterns and A1c changes among people with type 2 diabetes (T2D) using non-insulin therapy (NIT), basal insulin therapy (BIT), or intensive insulin therapy (IIT). We hypothesized that RT-CGM use would be associated with more frequent medication class changes and reduction in polypharmacy, alongside greater improvements in A1c compared to CGM non-use. Patients and Methods: This retrospective study analyzed US administrative claims data from the Optum Clinformatics Data Mart database between 09/01/2016 and 06/30/2024. People with T2D were divided into NIT, BIT, or IIT cohorts. Each cohort contained two groups: Dexcom RT-CGM users or CGM non-users and 1:1 propensity score matching was performed to minimize differences between the groups. We compared changes in medication use and A1c levels between RT-CGM users and CGM non-users over 12 months. Results: Over 1.6 million people with T2D were identified prior to matching and stratified by therapy regimen as T2D-NIT,-BIT, or-IIT. After propensity score matching, the proportion of RT-CGM users taking ≥4 medications declined significantly and RT-CGM users had more net changes in their medications than CGM non-users. In addition, greater improvements in A1c were observed among RT-CGM users compared to CGM non-users in all cohorts (difference-indifferences of-0.4%,-0.5%, and-0.4% for T2D-NIT, T2D-BIT, and T2D-IIT, respectively, all p<0.0001). More RT-CGM users also achieved a mean A1c <7.0% or <8.0% at follow-up overall and among those not meeting the target at baseline. Conclusion: Higher rates of medication changes were associated with RT-CGM use. RT-CGM use was associated with significantly and meaningfully improved A1c levels among all T2D cohorts. The findings indicate that RT-CGM use could help all people with T2D improve their glycemia.

Introduction: Continuous glucose monitoring (CGM) offers a detailed view of glycaemic management, potentially enhancing the effectiveness of non‐insulin, anti‐diabetes medications. This study aimed to evaluate whether CGM use in combination with anti‐diabetes medications is associated with changes in A1c among people with type 2 diabetes not using insulin. Materials and Methods: This was a retrospective, observational analysis of administrative claims and linked laboratory data from Optum's Clinformatics Data Mart database. The study observation period covered 01/07/2018 through 30/06/2023 with 6‐month baseline and follow‐up periods. CGM use in conjunction with ≥ 1 of five anti‐diabetes medication classes: metformin, sulfonylureas, sodium‐glucose cotransporter‐2 (SGLT2) inhibitors, dipeptidyl peptidase‐4 (DPP‐4) inhibitors and/or glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) was required. The primary outcome was change in A1c from baseline. Linear regression models tested the main and interaction effects of CGM and each anti‐diabetes medication. Results: Overall, 52,394 CGM‐naïve adults with non‐insulin‐treated type 2 diabetes using anti‐diabetes medications were identified (4086 CGM users; 48,308 CGM non‐users). CGM use was associated with a –0.45% greater A1c change among CGM users compared to CGM non‐users ( p < 0.0001). After adjusting for covariates, CGM users experienced greater A1c reductions vs. CGM non‐users with all medications, but statistically significant interactions showed that for DPP‐4 inhibitors, GLP‐1 RAs and sulfonylureas, there were greater decreases in A1c for CGM users vs. CGM non‐users who were taking the medication compared to CGM users vs. CGM non‐users who were not taking the medication. A1c change between CGM users vs. CGM non‐users did not vary by metformin or SGLT2 inhibitor use. Discussion: The findings suggest that CGM use could augment the glycaemic benefits of anti‐diabetes medications in people with non‐insulin treated type 2 diabetes. These results support broader adoption of CGM.

Introduction Some people with type 2 diabetes (T2D) require intensive insulin therapy to manage their diabetes. This can increase the risk of diabetes-related hospitalizations. We hypothesize that initiation of real-time continuous glucose monitoring (RT-CGM), which continuously measures a user’s glucose values and provides threshold- and trend-based alerts, will reduce diabetes-related emergency department (ED) and inpatient hospitalizations and concomitant costs. Methods A retrospective analysis of US healthcare claims data using Optum’s de-identified Clinformatics^® Data Mart database was performed. The cohort consisted of commercially insured, CGM-naïve individuals with T2D who initiated Dexcom G6 RT-CGM system between August 1, 2018, and March 31, 2021. Twelve months of continuous health plan enrollment before and after RT-CGM initiation was required to capture baseline and follow-up rates of diabetes-related hospitalizations and associated healthcare resource utilization (HCRU) costs. Analyses were performed for claims with a diabetes-related diagnosis code in either (1) any position or (2) first or second position on the claim. Results A total of 790 individuals met the inclusion criteria. The average age was 52.8 (10.5) [mean (SD)], 53.3% were male, and 76.3% were white. For claims with a diabetes-related diagnosis code in any position, the number of individuals 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 similarly decreased by at least 31.4%. Larger relative decreases were observed for claims with a diabetes-related diagnosis code in the first or second position on the claim. Total diabetes-related costs expressed as per-person-per-month (PPPM) decreased by $341 PPPM for any position and $330 PPPM for first or second position. Conclusion Initiation of Dexcom G6 among people with T2D using intensive insulin therapy was associated with a significant reduction in diabetes-related ED and inpatient visits and related HCRU costs. Expanded use of RT-CGM could augment these benefits and result in further cost reductions.

Key Points: Patients with diabetes and CKD have a heightened risk of glycemic variability, which can lead to severe hypoglycemic or hyperglycemic events, potentially resulting in hospitalization. This study describes the results of a retrospective claims analysis of people with insulin-requiring type 2 diabetes and stage 3–5 CKD who initiated continuous glucose monitoring. Continuous glucose monitoring could help patients with type 2 diabetes and CKD control their glucose and avoid potentially dangerous glycemic events. Background: There is a heightened risk of glycemic variability in patients with diabetes and CKD. This glycemic variability could lead to hypoglycemic or hyperglycemic crises. We hypothesized that initiation of continuous glucose monitoring (CGM), which provides a glucose measurement every 1–5 minutes, could reduce the incidence of hospitalizations for patients with type 2 diabetes (T2D) and CKD. Methods: A retrospective analysis of US administrative claims data from the Optum Clinformatics database was conducted. People with T2D, using insulin, not receiving dialysis, and living with stage 3–5 CKD who initiated CGM between January 1, 2016, and March 31, 2022, were identified. National Drug Codes and Healthcare Common Coding Procedure System codes were used to identify CGM device use, and International Classification of Diseases 10th revision codes were used to identify CKD diagnosis and categorize health care encounters. Rates of diabetes-related hospitalizations were obtained, and multivariable logistic regression analyses revealed predictors of hypoglycemic and hyperglycemic encounters. Results: A total of 8,959 insulin-using patients with T2D and CKD were identified. Most were White (72.3%), had Medicare insurance coverage (82.2%), were using intensive insulin (91.3%), and had stage 3 CKD (86.0%). After CGM initiation, rates of hospitalizations for hyperglycemia or hypoglycemia decreased by 18.2% and 17.0%, respectively (P < 0.0001 for both). The proportion hospitalized with at least one hypoglycemic or hyperglycemic event also significantly decreased after CGM initiation. Significant predictors of both hypoglycemic and hyperglycemic encounters included a previous encounter of that type, age 30–59 years and depression (for hypoglycemia), and age 30–49 years and neuropathy (for hyperglycemia). Use of CGM or glucagon-like peptide-1 receptor agonists was significantly protective against hypoglycemic encounters. Conclusions: Initiation of CGM was associated with significant reductions in diabetes-related hospitalizations among insulin-using individuals with T2D and moderate-to-severe CKD. CGM could help patients with T2D and CKD control their glucose and avoid potentially dangerous glycemic events.

Introduction Use of continuous glucose monitoring (CGM) systems by people with diabetes is associated with improved glycemic outcomes, including lower glycated hemoglobin (A1C). Less is known about adherence to CGM systems, whether glycemic outcomes are impacted by levels of adherence, or whether adherence rates differ between types of CGM systems—intermittently scanned CGM (isCGM) or real-time CGM (rtCGM). Methods A retrospective analysis of de-identified US administrative health claims and linked laboratory data was conducted using the Merative™ MarketScan^® Research Database. The cohort included CGM-naïve people with type 1 diabetes (T1D) or type 2 diabetes treated with intensive insulin therapy (T2D-IIT) who initiated rtCGM or isCGM between August 1, 2019 and March 31, 2021 (defined as the index date). Adherence was calculated over a 12-month period using the proportion of days covered (PDC) with PDC ≥ 0.8 defined as adherent. A1C values were obtained within 6 months of the index date. Results A total of 7669 individuals were identified. Subgroups included T1D using isCGM (n = 1578), T1D using rtCGM (n = 1244), T2D-IIT using isCGM (n = 3567), and T2D-IIT using rtCGM (n = 1280). After 12 months, PDC was 0.71 (0.30)–0.72 (0.31) (mean(SD)) for T1D and T2D-IIT rtCGM users and 0.55 (0.34)–0.56 (0.34) for T1D and T2D-IIT isCGM users. The proportion of adherent users (PDC ≥ 0.8) was 56.8–59.7% for rtCGM users and 36.3–37.6% for isCGM users. Overall, regardless of diabetes type, the odds of adherence were over two times higher for rtCGM users compared to isCGM users. For those with available A1C information (T1D n = 213; T2D-IIT n = 346), independent of CGM type, adherence to CGM was associated with a greater reduction in A1C and more people reaching A1C targets of < 7.0% or < 8.0%. Conclusion For people with T1D or T2D-IIT, higher adherence to CGM is associated with greater reductions in A1C, and higher adherence rates were observed with rtCGM systems than with isCGM systems.