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. 2022 Feb 1;45(2):391-397.
doi: 10.2337/dc21-1666.

Universal Subsidized Continuous Glucose Monitoring Funding for Young People With Type 1 Diabetes: Uptake and Outcomes Over 2 Years, a Population-Based Study

Stephanie R Johnson  1   2 , Deborah J Holmes-Walker  3   4 , Melissa Chee  5 , Arul Earnest  6 , Timothy W Jones  7   8 ; ADDN Study Group:; Maria Craig, Kym Anderson, Geoff Ambler, Helen Barrett, Jenny Batch, Philip Bergman, Fergus Cameron, Peter Colman, Louise Conwell, Chris Cooper, Jennifer Couper, Elizabeth Davis, Martin de Bock, Kim Donaghue, Jan Fairchild, Gerry Fegan, Spiros Fourlanos, Sarah Glastras, Leonie Gray, Shane Hamblin, Paul Hofman, Dianne Jane Holmes-Walker, Neville Howard, Michelle Jack, Steven James, Craig Jefferies, Stephanie Johnson, Jeff Kao, Bruce R King, Antony Lafferty, Michelle Martin, Robert McCrossin, Mark Pascoe, Ryan Paul, Dorota Pawlak, Alexia Peña, Sarah Price, Darrell Price, Christine Rodda, David Simmons, Richard Sinnott, Alan Sive, Carmel Smart, Monique Stone, Steve Stranks, Elaine Tham, Charles Verge, Glenn Ward, Ben Wheeler, Judy Williams, Helen Woodhead, Nick Woolfield, Anthony Zimmermann
Affiliations

Universal Subsidized Continuous Glucose Monitoring Funding for Young People With Type 1 Diabetes: Uptake and Outcomes Over 2 Years, a Population-Based Study

Stephanie R Johnson et al. Diabetes Care. .

Abstract

Objective: Continuous glucose monitoring (CGM) is increasingly used in type 1 diabetes management; however, funding models vary. This study determined the uptake rate and glycemic outcomes following a change in national health policy to introduce universal subsidized CGM funding for people with type 1 diabetes aged <21 years.

Research design and methods: Longitudinal data from 12 months before the subsidy until 24 months after were analyzed. Measures and outcomes included age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycemia, insulin regimen, CGM uptake, and percentage CGM use. Two data sources were used: the Australasian Diabetes Database Network (ADDN) registry (a prospective diabetes database) and the National Diabetes Service Scheme (NDSS) registry that includes almost all individuals with type 1 diabetes nationally.

Results: CGM uptake increased from 5% presubsidy to 79% after 2 years. After CGM introduction, the odds ratio (OR) of achieving the HbA1c target of <7.0% improved at 12 months (OR 2.5, P < 0.001) and was maintained at 24 months (OR 2.3, P < 0.001). The OR for suboptimal glycemic control (HbA1c ≥9.0%) decreased to 0.34 (P < 0.001) at 24 months. Of CGM users, 65% used CGM >75% of time, and had a lower HbA1c at 24 months compared with those with usage <25% (7.8 ± 1.3% vs. 8.6 ± 1.8%, respectively, P < 0.001). Diabetic ketoacidosis was also reduced in this group (incidence rate ratio 0.49, 95% CI 0.33-0.74, P < 0.001).

Conclusions: Following the national subsidy, CGM use was high and associated with sustained improvement in glycemic control. This information will inform economic analyses and future policy and serve as a model of evaluation diabetes technologies.

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Figures

Figure 1
Figure 1
Mean HbA1c over time. The diamonds (♦) represent individuals with diabetes who did not use CGM (non-CGM), the circles (●) represent those who were using CGM <25% of the time, and the squares (▪) represent patients who were using CGM >75% of the time. Data are mean ± 95% CIs.
See this image and copyright information in PMC

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