Evaluation of the Effectiveness of Continuous Glucose Monitors on Glycemic Control in Patients With Type 2 Diabetes Receiving Institutional Financial Assistance.

Abstract

Background: Current guidelines suggest utilizing continuous glucose monitoring (CGM) to improve hemoglobin A_1c (HbA_1c) in patients with diabetes. Financial cost remains a barrier to implementation. Medicare coverage criteria include all patients with diabetes treated with at least one injection of insulin per day, while Washington Medicaid is more restrictive. There remains a paucity of literature examining effectiveness of CGMs on clinical outcomes among patients with type 2 diabetes with lower incomes.

Methods: This is a single-center, retrospective, observational study including adults with type 2 diabetes receiving institutional financial assistance for CGMs. A cohort with no CGM use is included for comparison. The primary outcome is change in HbA_1c approximately three months after CGM implementation from baseline. Secondary outcomes include mean differences in number of antidiabetic agents and changes in insulin dose prior to and after CGM implementation.

Results: Among the CGM cohort, most patients were of Hispanic ethnicity (77%) and a majority had no insurance (77%). The average HbA_1c prior to CGM implementation was 8.3% and three months post-CGM was 7.7%, with a mean difference of -0.6% (P = .004). There were no statistically significant differences in the average number of antidiabetic agents, total daily dosages of insulin, or mean differences in the number of emergency room visits or hospitalizations prior to and post-implementation of a CGM.

Conclusion: Overall, there is a statistical and clinical improvement in HbA_1c before and after implementation of CGMs in patients with type 2 diabetes who meet Medicaid criteria for CGM coverage receiving financial assistance.