Flash CGM Reduces Diabetes-Related Events, Hospitalizations in Insulin-Treated T2D

Richard Bergenstal, MD

An analysis of real-world data by the International Diabetes Center indicates use of flash continuous glucose monitoring (CGM) was linked to reductions in adverse diabetes events and hospitalizations among insulin-treated patients with type 2 diabetes and no prior CGM use.

Results of the analysis, which included data from the IBM MarketScan Commercial Claims and Medicare Supplemental databases, indicate use of a flash CGM system was associated with a 60% reduction in risk of acute diabetes-related events and a 30% reduction in risk of all-cause hospitalizations, regardless of age gender.

“What makes our findings unique is that we saw a notable reduction in acute diabetes-related events and all-cause hospitalizations within the first 45 days of the flash CGM post-acquisition period. Additionally, our findings from a real-world large patient cohort are consistent with results from prospective, observational studies involving both type 1 and type 2 diabetes,” wrote study investigators.

With the prevalence of diabetes expected to increase moving forward, methods of mitigating dysglycemia risk among patients with diabetes have the potential to reduce adverse events and disease burden on individuals and healthcare systems as a whole. To further assess how improvements in glycemic control associated with acquisition of flash CGM system might impact risk of adverse events, the current study was designed as a retrospective analysis of real-world data from the aforementioned databases.

For inclusion in the analysis, patients needed to be at least 18 years old, have a diagnosis of type 2 diabetes, had no history of CGM use, and acquired either the 10-day or 14-day sensor system between November 2017 and September 2018. Overall, 2,463 individuals with type 2 diabetes were identified for inclusion in the current study.

The study cohort had a mean age of 54.2 (SD, 9.6) years and 52.9% were men. The most common comorbidities were lipid disorders (89.7%), hypertension (87.5%), and obesity (60.0%). Investigators noted 93.5% of individuals were commercially insured and 6.5% had Medicare Supplemental Insurance.

The primary outcome of the study was change in acute diabetes-related events in the first 6 months following acquisition of a flash CGM system compared to the 6-mopnth period prior to use. For the purpose of analysis, acute events was defined as hypoglycemia, hypoglycemic coma, clinical hyperglycemia, diabetic ketoacidosis (DKA), and hyperosmolarity. Change in rates of all-cause hospitalizations was considered a secondary outcome for the analysis.

During the 6-month period following acquisition, results indicated the rate of acute diabetes-related events was reduced from 0.180 to 0.072 events per patient-year (HR, 0.39; 95% CI, 0.30-0.51; P <.001) and the rates of all-cause hospitalizations was reduced from 0.420 to 0.283 events per patient-year (HR, 0.68; 95% CI, 0.59-0.78; P <.001).

Investigators noted multiple limitations to consider when interpreting the results of their study. Among these are the use of claims data, the inability to assess behaviors related to use of the flash CGM system, and the inability to generalize results to older populations.

“Further investigation of how patients utilize their glucose data in day-to-day diabetes management might provide additional insights that could guide the development of educational strategies and mechanisms for ongoing patient support systems that would encourage both persistent and appropriate use of the system,” wrote investigators.

This study, “Flash CGM Is Associated with Reduced Diabetes Events and Hospitalizations in Insulin-Treated Type 2 Diabetes,” was published in the Journal of the Endocrine Society.