Background: Continuous glucose monitoring (CGM) improves diabetes control by reducing HbA1c and decreasing rates of hypoglycemia. Despite clinical benefits and clear guidelines from the American Diabetes Association, <20% of patients with T1DM use CGM. Studies report disparities in CGM among youth with T1D by race/ethnicity, socioeconomic status, and region, but, insight into patterns of CGM utilization in adults with T1D is limited.
Methods: We evaluate CGM utilization among individuals with T1D age ≥18 using Truven MarketScan and Medicare Supplementary databases from 1/1/2016-12/31/2019. CGM utilization was determined using CPT, NDC and HCPCS codes. Individuals with >365 days of continuous eligibility were followed from their first diabetes-related diagnosis code until: end of the study period, >120 day gap in coverage, or CGM claim. CGM utilization was analyzed by patient demographics (age, sex, region, employment status) , and clinical characteristics (insulin pump, diabetes complications) .
Results: A total of 228,846 enrollees with T1D were included. Average (SD) age at baseline was 52.2 (16.8) ; 47% of the sample was female, 26% were on an insulin pump and the regional distribution of was: 26% North Central, 21% Northeast, 41% South, 11% West. Overall, 36.5% (n=60,034) of beneficiaries had a claim for CGM. Rates of CGM utilization ranged from 59% in those aged 18-25 to 16% in those 65+ (p<0.0001) , 38% in women vs. 35% in men (p<0.0001) , and 34% in North Central and Northeastern US vs. 40.2% in West (p<0.0001) .
Conclusions: We found differential utilization of CGM by sex, age group and geographic region. Those aged 18-25 were 3 times more likely to utilize CGM compared to those 65+, a subgroup at high risk for severe hypoglycemic events and hypoglycemia unawareness. CGM is a highly effective tool for improving glucose control and preventing acute hypoglycemia, yet only 1/3 of the population sampled had evidence of use underscoring the need to understand barriers to utilization.
K.E.Lee: None. J.Fowlkes: None. M.E.Lacy: None.
National Institutes of Health (UL1TR000117, UL1TR001998, KL2TR001996)