在1型糖尿病患者中使用连续血糖监测(CGM)与较高的医疗费用、住院率增加和现实环境中的社会差异有关:大型综合卫生系统中采用模式、对卫生服务利用和护理成本的影响分析

IF 1.4 Q4 ENDOCRINOLOGY & METABOLISM
Ameer Khowaja , Lina Adil , Teigan Dwyer , Tyson Barrett , Jamil Alkhaddo
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引用次数: 0

摘要

随着1型糖尿病(DM)患病率的上升,连续血糖监测(CGM)已成为一种重要的管理工具。虽然研究表明CGM可以改善血糖控制,但其对医疗保健利用和成本的广泛影响仍然有限。本研究评估了使用CGM和不使用CGM的1型糖尿病患者的人口学和临床差异;评估医疗保健利用、血糖结果、成本和对耐用医疗设备(DME)的影响。方法利用2019 - 2021年阿勒格尼健康网络(AHN)的医疗保险理赔和电子病历进行回顾性队列分析。患者资格要求连续36个月的医疗和药品保险;胰岛素使用与AHN关系。该队列包括3007例患者,分为CGM使用者和非使用者。此外,患者数据按人口统计学、社会脆弱性指数(SVI)、每个成员每月(PMPM)和1000人月进行分层。结果与非cgm用户相比,scgm用户在除DME外的所有服务类型中均具有更高的PMPM和利用率/1000。CGM使用者的处方成本逐步增加(处方PMPM, 2019年:621.33美元,2020年:723.97美元,2021年:851.39美元)。非cgm使用者的处方相关费用更高,占总费用的43%,但达到HbA1c 9.0的可能性更高。CGM使用者的住院次数明显高于非CGM使用者(18.4%比10.55%,p <;0.001)。CGM的使用在非白种人、非英语人群和吸烟人群中更为常见,但随着SVI的增加而下降。服用CGM的人身体虚弱、抑郁、充血性心力衰竭和癫痫发作的几率更高。结论本研究强调了1型糖尿病患者CGM摄取的复杂性及其对医疗费用的影响。与CGM使用相关的医疗保健支出增加,引发了对成本效益和可及性的担忧。需要进一步的研究来评估不同人口统计和社会经济群体在CGM利用和糖尿病管理方面的差异,包括糖尿病相关并发症和相关费用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Continuous Glucose Monitoring (CGM) use in patients with diabetes mellitus type 1 is associated with higher healthcare costs, increased hospitalizations, and social disparities in a real-world setting: Analysis of adoption pattern, impact on health services utilization and cost of care in a large integrated health system

Background

With the rising prevalence of diabetes mellitus type 1 (DM type 1), continuous glucose monitoring (CGM) has emerged as a key management tool. While studies suggest CGM improves glycemic control, its broader impact on healthcare utilization and costs remains limited. This study evaluates demographic and clinical variations between DM type 1 patients using CGM and non-CGM users; assessing healthcare utilization, glycemic outcomes, costs and impact on Durable Medical Equipment (DME).

Methods

A retrospective cohort analysis was conducted using health insurance claims and electronic medical records from Allegheny Health Network (AHN) from 2019 to 2021. Patient eligibility required 36 months of continuous medical and drug coverage; insulin use and AHN affiliation. The cohort included 3007 patients, divided into CGM users and non-users. Additionally, patient data was stratified by demographics, social vulnerability index (SVI), healthcare use by per member per month (PMPM) and 1000 person-months.

Results

CGM users had higher PMPM and utilization/1000 for all service types, except for DME, when compared to non-CGM users. There was a progressive increase in the cost of prescriptions among CGM users (prescription PMPM, 2019: $621.33, 2020: $723.97, 2021: $851.39). Non-CGM users had greater prescription-related expenses, comprising 43 % of total costs but a higher likelihood of achieving an HbA1c <9.0. Number of hospitalizations was significantly higher among CGM users compared to non-CGM users (18.4 % vs. 10.55 %, p < 0.001). CGM use was more common among non-Caucasian, non-English-speaking, and tobacco-using groups but declined with increasing SVI. CGM users had higher rates of frailty, depression, congestive heart failure and seizures.

Conclusion

This study highlights the complexity of CGM uptake and its impact on healthcare costs in DM type 1 patients. Increased healthcare spending associated with CGM use raises concerns about cost-effectiveness and accessibility. Further studies are needed to assess disparities in CGM utilization and diabetes management including diabetes-related complications and associated costs across varying demographics and socioeconomic groups.
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来源期刊
Diabetes epidemiology and management
Diabetes epidemiology and management Endocrinology, Diabetes and Metabolism, Public Health and Health Policy
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