Cheng Kevin K, Vera Cruz Maxine F, Tylee Tracy S, Kelly Mary S
Department of Pharmacy, University of Washington Medicine, Seattle, WA, USA.
University of Washington School of Medicine, Seattle, WA, USA.
J Diabetes Sci Technol. 2025 Feb 20:19322968251320122. doi: 10.1177/19322968251320122.
Current guidelines suggest utilizing continuous glucose monitoring (CGM) to improve hemoglobin A (HbA) in patients with diabetes. Financial cost remains a barrier to implementation. Medicare coverage criteria include all patients with diabetes treated with at least one injection of insulin per day, while Washington Medicaid is more restrictive. There remains a paucity of literature examining effectiveness of CGMs on clinical outcomes among patients with type 2 diabetes with lower incomes.
This is a single-center, retrospective, observational study including adults with type 2 diabetes receiving institutional financial assistance for CGMs. A cohort with no CGM use is included for comparison. The primary outcome is change in HbA approximately three months after CGM implementation from baseline. Secondary outcomes include mean differences in number of antidiabetic agents and changes in insulin dose prior to and after CGM implementation.
Among the CGM cohort, most patients were of Hispanic ethnicity (77%) and a majority had no insurance (77%). The average HbA prior to CGM implementation was 8.3% and three months post-CGM was 7.7%, with a mean difference of -0.6% ( = .004). There were no statistically significant differences in the average number of antidiabetic agents, total daily dosages of insulin, or mean differences in the number of emergency room visits or hospitalizations prior to and post-implementation of a CGM.
Overall, there is a statistical and clinical improvement in HbA before and after implementation of CGMs in patients with type 2 diabetes who meet Medicaid criteria for CGM coverage receiving financial assistance.
当前指南建议使用持续葡萄糖监测（CGM）来改善糖尿病患者的糖化血红蛋白（HbA）。财务成本仍然是实施的障碍。医疗保险覆盖标准包括所有每天至少注射一次胰岛素治疗的糖尿病患者，而华盛顿医疗补助计划的限制则更多。对于低收入的2型糖尿病患者，研究CGM对临床结局有效性的文献仍然很少。
这是一项单中心、回顾性观察性研究，纳入了接受机构财务援助以使用CGM的2型糖尿病成年患者。纳入一个未使用CGM的队列作为对照。主要结局是CGM实施后约三个月HbA相对于基线的变化。次要结局包括CGM实施前后抗糖尿病药物数量的平均差异以及胰岛素剂量的变化。
在CGM队列中，大多数患者为西班牙裔（77%），且大多数没有保险（77%）。CGM实施前的平均HbA为8.3%，CGM实施后三个月为7.7%，平均差异为-0.6%（P = .004）。在CGM实施前后，抗糖尿病药物的平均数量、胰岛素的每日总剂量、急诊就诊次数或住院次数的平均差异均无统计学意义。
总体而言，对于符合医疗补助计划CGM覆盖标准并接受财务援助的2型糖尿病患者，实施CGM前后HbA在统计学和临床上均有改善。
