Presenter:
Kyle Semmel, PharmD, lead author
Research Team:
Ashley N. Chiara, PharmD, MBA, BCPS
Kaelyn C. Boss, PharmD
Thomas C. Pomfret, PharmD, MPH, BCPS
Caroline J. Alper, MD
Karen Clements, ScD
Diala Nicolas, PharmD, BCPS
Rachel Bacon, PharmD, MPH
Neha Kashalikar, PharmD
Sana Mandal, PharmD, BCPS
Jennifer Banks, PharmD
Kimberly Lenz, PharmD, MBA, FAMCP
Continuous glucose monitors (CGM) are software-equipped devices that patients with diabetes use to monitor blood glucose levels. The American Diabetes Association (ADA) recommends the use of CGM in those requiring multiple daily insulin injections, continuous insulin infusions, or basal insulin.
Clinical trials assessing the use of CGM in patients with insulin-dependent type 2 diabetes mellitus (T2DM) have shown reductions in hemoglobin A1c (HbA1c or the average amount of sugar in your blood over the past few months), but not in the rates of hypoglycemia (a condition in which your blood sugar—glucose—level is lower than the standard range). Healthcare providers assess HbA1C levels to help diagnose Type 2 diabetes and to monitor how well your diabetes treatment plan is working. If diabetic hypoglycemia isn’t treated, signs and symptoms can include confusion, loss of coordination, slurred speech, inability to eat or drink, or severe symptoms like seizures or unconsciousness.
This research compared the incidences and costs of diabetes-related emergency department (ED) visits, hospitalizations, and blood glucose monitoring-related supplies among adult members in a state Medicaid program with insulin-dependent T2DM who monitor glucose levels with CGM versus CBG testing.
The team found that the cost of care per member per year (PMPY) was higher in the CGM group than the CBG group, suggesting that members using CGM may be of higher acuity and require additional interventions and medical attention compared to members using CBG alone. Members using CGM had a higher medical spend than members using CBG by $105 PMPY. Members with T2DM who monitor blood glucose levels with CGM had higher associated overall health plan expenditures on a PMPY basis compared to members on CBG alone, as indicated by the difference in total PMPY spend of $1,295.
Future evaluations should be conducted stratifying baseline disease severity to determine the more precise clinical and financial implications of CGM devices from a health plan perspective.