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Observational Study
. 2023 Mar;17(2):322-328.
doi: 10.1177/19322968211049783. Epub 2021 Oct 9.

Patient Demographics and Clinical Outcomes Among Type 1 Diabetes Patients Using Continuous Glucose Monitors: Data From T1D Exchange Real-World Observational Study

Daniel J DeSalvo  1 , Nudrat Noor  2 , Cicilyn Xie  3 , Sarah D Corathers  4 , Shideh Majidi  5 , Ryan J McDonough  6 , Sarit Polsky  5 , Roberto Izquierdo  7 , Nicole Rioles  2 , Ruth Weinstock  7 , Kathryn Obrynba  8 , Alissa Roberts  9 , Francesco Vendrame  10 , Janine Sanchez  10 , Osagie Ebekozien  2   11
Affiliations
Observational Study

Patient Demographics and Clinical Outcomes Among Type 1 Diabetes Patients Using Continuous Glucose Monitors: Data From T1D Exchange Real-World Observational Study

Daniel J DeSalvo et al. J Diabetes Sci Technol. 2023 Mar.

Abstract

Background: The benefits of Continuous Glucose Monitoring (CGM) on glycemic management have been demonstrated in numerous studies; however, widespread uptake remians limited. The aim of this study was to provide real-world evidence of patient attributes and clinical outcomes associated with CGM use across clinics in the U.S. based T1D Exchange Quality Improvement (T1DX-QI) Collaborative.

Method: We examined electronic Health Record data from eight endocrinology clinics participating in the T1DX-QI Collaborative during the years 2017-2019.

Results: Among 11,469 type 1 diabetes patients, 48% were CGM users. CGM use varied by race/ethnicity with Non-Hispanic Whites having higher rates of CGM use (50%) compared to Non-Hispanic Blacks (18%) or Hispanics (38%). Patients with private insurance were more likely to use CGM (57.2%) than those with public insurance (33.3%) including Medicaid or Medicare. CGM users had lower median HbA1c (7.7%) compared to nonusers (8.4%). Rates of diabetic ketoacidosis (DKA) and severe hypoglycemia were significantly higher in nonusers compared to CGM users.

Conclusion: In this real-world study of patients in the T1DX-QI Collaborative, CGM users had better glycemic control and lower rates of DKA and severe hypoglycemia (SH) events, compared to nonusers; however, there were significant sociodemographic disparities in CGM use. Quality improvement and advocacy measures to promote widespread and equitable CGM uptake have the potential to improve clinical outcomes.

Keywords: Type 1; continuous glucose monitoring; diabetes mellitus; diabetic ketoacidosis; hemoglobin A1c; severe hypoglycemia.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DJD has received independent consulting fees from Dexcom and Insulet. N. N., C. X., S. D. C., S. M., R. J. M., S. P., R. I., N. R., R. W., K. O., A. R., F. V., J. S., and O. E. have no disclosures.

Figures

Figure 1.
Figure 1.
Patient attributes and CGM use. (a) CGM use by age in the T1DX-QI Collaborative. (b) CGM use by race/ethnicity in the T1DX-QI Collaborative. (c) CGM use by insurance status in the T1DX-QI Collaborative. Abbreviations: CGM, continuous glucose monitoring; T1DX-QI, T1D Exchange Quality Improvement.
Figure 2.
Figure 2.
HbA1c levels by CGM nonusers versus CGM users in the T1D Exchange Quality Improvement Collaborative. (Median [IQR]: 8.4% [7.4%, 9.5%] for nonusers vs. 7.7% [6.9%, 8.6%] for CGM users; P < .001). Abbreviations: CGM, continuous glucose monitoring.
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