Abstract
Background and Aims
Continuous glucose monitors (CGMs) simplify diabetes management by removing need for multiple daily finger-stick blood samples. We aim to describe CGM real-world clinical outcomes in patients with Type 1 and Type 2 diabetes (T1D, T2D), including those using less than four test-strips (L4S) pre-CGM.
Methods
IBM MarketScan™ Commercial Claims and Medicare Supplemental databases, 2016 Q1–2018 Q3, were used in this retrospective, observational analysis. MarketScan™ contains insurance billing claims for inpatient, outpatient, and pharmacy expenses. De novo CGM-users with fast-acting insulin, test strip purchases, and ≥ 6-months pre-CGM observation time were selected. L4S was defined as <4 strips/day over 6 months pre-CGM. Primary outcome was acute diabetes complication events per patient-year (ev/pt-yr) due to hyper-/hypoglycemia occurring in an inpatient or emergency outpatient setting. Andersen-Gill Cox regression compared event rates 6-months pre-/post-CGM.
Results
The overall T1D cohort (n=7,648, age 33.6±18.4 years, 49.7% male) experienced a reduction in acute diabetes complications from 0.37 to 0.15 ev/pt-yr (HR: 0.39 [0.35 0.43]; P:<0.001). A similar reduction was seen in the T1D L4S subset (n=4,211, 0.43 to 0.18 ev/pt.-yr, HR: 0.40 [0.36 0.46]; P:<0.001). The overall T2D cohort (n=1,129, age 53.6±13.1 years, 54.8% male) also saw a significant reduction in events from 0.23 to 0.10 ev/pt-yr (HR: 0.45 [0.33 0.62]; P:<0.001), as did the T2D L4S cohort (n=836, 0.22 to 0.11 ev/pt-yr, HR: 0.50 [0.35 0.72]; P:<0.001).
Conclusions
Lower acute diabetes complications post-CGM purchase support the real-world effectiveness of CGMs, even in diabetics with history of lower test-strip usage.
