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. 2023 Mar;25(3):169-177.
doi: 10.1089/dia.2022.0418. Epub 2023 Jan 4.

Impact of Expanding Access to Continuous Glucose Monitoring Systems Among Insulin Users with Type 1 or Type 2 Diabetes

Shweta Pathak  1 , Kristina Kearin  2 , Anna R Kahkoska  3 , Kathryn A Fuller  2 , Bradley Staats  4 , Joseph Albright  5 , Til Stürmer  6 , John B Buse  7 , Benjamin Y Urick  2   8
Affiliations

Impact of Expanding Access to Continuous Glucose Monitoring Systems Among Insulin Users with Type 1 or Type 2 Diabetes

Shweta Pathak et al. Diabetes Technol Ther. 2023 Mar.

Abstract

Background: Despite increased use of continuous glucose monitoring (CGM) systems, studies to quantify patterns of CGM use are limited. In December 2018, a policy change by a commercial insurer expanded coverage of CGM through the pharmacy benefit, creating an opportunity to evaluate the impact of this change on CGM utilization. Research Design and Methods: Pharmacy and medical claims from 2016 to 2020 were used to estimate the prevalence of CGM use among insulin users with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) before and after the policy change. Change in CGM use was assessed using an interrupted time series design. Results: At the beginning of the study period, 18.8% of T1DM patients and 1.2% of T2DM patients used CGM. Use rose to 30.5% and 6.6% in the quarter before the policy change. The policy resulted in an immediate 9.5% (P < 0.0001) and 2.8% (P < 0.0001) change in use and increased the rate of quarterly change by 0.5% (P = 0.002) and 0.8% (P < 0.0001). At the end of the study period, 58.2% and 14.9% of T1DM and T2DM patients used CGM. Conclusion: CGM use significantly increased after addition to the pharmacy benefit. Rate of change in CGM use was lower in T1DM compared to the T2DM population, but overall use remained higher among patients with T1DM. Increased CGM use in the population studied aligns with those whose clinical guidelines suggest would most likely benefit. Additional work is needed to evaluate the impact of this benefit change on health care spending and outcomes.

Keywords: Continuous glucose monitor use; Type 1 diabetes; Type 2 diabetes.

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Conflict of interest statement

At the time of this work, B.Y.U. was an employee of the University of North Carolina. He is currently a Principal Health Outcomes Researcher with Prime Therapeutics, which contracts with Blue Cross NC to provide pharmacy benefits. T.S. receives investigator-initiated research funding and support as Principal Investigator (R01AG056479) from the National Institute on Aging (NIA), and as Co-Investigator (R01CA174453, R01HL118255, R01MD011680), National Institutes of Health (NIH). He also receives salary support as Director of Comparative Effectiveness Research (CER), NC TraCS Institute, UNC Clinical and Translational Science Award (UL1TR002489), the Center for Pharmacoepidemiology (current members: GlaxoSmithKline, UCB BioSciences, Takeda, AbbVie, Boehringer Ingelheim), from pharmaceutical companies (Novo Nordisk), and from a generous contribution from Dr. Nancy A. Dreyer to the Department of Epidemiology, University of North Carolina at Chapel Hill.

T.S. does not accept personal compensation of any kind from any pharmaceutical company. He owns stock in Novartis, Roche, and Novo Nordisk. A.R.K. is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR002490. A.R.K. also reports receiving a research grant from the Diabetes Research Connection outside the submitted work. J.B.B. is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR002489. Contracted consulting fees and travel support for contracted activities for his efforts from Novo Nordisk are paid to the University of North Carolina. J.B.B. has grant support from Dexcom, NovaTarg, Novo Nordisk, Sanofi, Tolerion and vTv Therapeutics.

J.B.B. is a consultant to Alkahest, Altimmune, Anji, AstraZeneca, Bayer, Biomea Fusion, Inc., Boehringer-Ingelheim, CeQur, Cirius Therapeutics, Inc., Dasman Diabetes Center (Kuwait), Eli Lilly, Fortress Biotech, GentiBio, Glycadia, Glyscend, Janssen, MannKind, Mediflix, Medscape, Mellitus Health, Moderna, Pendulum Therapeutics, Praetego, ReachMD, Sanofi, Stability Health, Valo, and Zealand Pharma. J.B.B. has stock/options in Glyscend, Mellitus Health, Pendulum Therapeutics, PhaseBio, Praetego, and Stability Health.

Figures

FIG. 1.
FIG. 1.
Actual versus predicted LPM estimates of CGM use by insurance source, type 1 diabetes. Estimate of percentage points change in CGM use was adjusted for gender, age, rurality, endocrinologist care, care from DCES or receipt of MNT, hospitalizations, ED visits, hypoglycemic events, hyperglycemic events, count of chronic conditions, presence of diabetes-related complications, and type of insulin. CGM, continuous glucose monitoring; DCES, diabetes care and education specialist; ED, emergency department; LPM, Linear Probability Model; MNT, medical nutrition therapy; T1DM, type 1 diabetes mellitus; Ins Type, Insurance Type/Source.
FIG. 2.
FIG. 2.
Actual versus predicted LPM estimates of CGM use by insurance source, type 2 diabetes. Estimate of percentage points change in CGM use was adjusted for gender, age, rurality, endocrinologist care, care from DCES or receipt of MNT, hospitalizations, ED visits, hypoglycemic events, hyperglycemic events, count of chronic conditions, presence of diabetes-related complications, and type of insulin. T2DM, type 2 diabetes mellitus.
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