Flash CGM Is Associated With Reduced Diabetes Events and Hospitalizations in Insulin-Treated Type 2 Diabetes

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Abstract

Purpose

Suboptimal glycemic control among individuals with diabetes is a leading cause of hospitalizations and emergency department utilization. Use of flash continuous glucose monitoring (flash CGM) improves glycemic control in type 1 and type 2 diabetes, which may result in lower risk for acute and chronic complications that require emergency services and/or hospitalizations.

Methods

In this retrospective, real-world study, we analyzed IBM MarketScan Commercial Claims and Medicare Supplemental databases to assess the impact of flash CGM on diabetes-related events and hospitalizations in a cohort of 2463 individuals with type 2 diabetes who were on short- or rapid-acting insulin therapy. Outcomes were changes in acute diabetes-related events (ADE) and all-cause inpatient hospitalizations (ACH), occurring during the first 6 months after acquiring the flash CGM system compared with event rates during the 6 months prior to system acquisition. ICD-10 codes were used to identify ADE for hypoglycemia, hypoglycemic coma, hyperglycemia, diabetic ketoacidosis, and hyperosmolarity.

Results

ADE rates decreased from 0.180 to 0.072 events/patient-year (hazard ratio [HR]: 0.39 [0.30, 0.51]; P < 0.001) and ACH rates decreased from 0.420 to 0.283 events/patient-year (HR: 0.68 [0.59 0.78]; P < 0.001). ADE reduction occurred regardless of age or gender.

Conclusions

Acquisition of the flash CGM system was associated with reductions in ADE and ACH. These findings provide support for the use of flash CGM in type 2 diabetes patients treated with short- or rapid-acting insulin therapy to improve clinical outcomes and potentially reduce costs.

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Most cited references 38

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Economic Costs of Diabetes in the U.S. in 2017

(2018)

OBJECTIVE This study updates previous estimates of the economic burden of diagnosed diabetes and quantifies the increased health resource use and lost productivity associated with diabetes in 2017. RESEARCH DESIGN AND METHODS We use a prevalence-based approach that combines the demographics of the U.S. population in 2017 with diabetes prevalence, epidemiological data, health care cost, and economic data into a Cost of Diabetes Model. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, insurance coverage, medical condition, and health service category. Data sources include national surveys, Medicare standard analytical files, and one of the largest claims databases for the commercially insured population in the U.S. RESULTS The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity. For the cost categories analyzed, care for people with diagnosed diabetes accounts for 1 in 4 health care dollars in the U.S., and more than half of that expenditure is directly attributable to diabetes. People with diagnosed diabetes incur average medical expenditures of ∼$16,750 per year, of which ∼$9,600 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures ∼2.3 times higher than what expenditures would be in the absence of diabetes. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work because of disease-related disability ($37.5 billion), and lost productivity due to 277,000 premature deaths attributed to diabetes ($19.9 billion). CONCLUSIONS After adjusting for inflation, economic costs of diabetes increased by 26% from 2012 to 2017 due to the increased prevalence of diabetes and the increased cost per person with diabetes. The growth in diabetes prevalence and medical costs is primarily among the population aged 65 years and older, contributing to a growing economic cost to the Medicare program. The estimates in this article highlight the substantial financial burden that diabetes imposes on society, in addition to intangible costs from pain and suffering, resources from care provided by nonpaid caregivers, and costs associated with undiagnosed diabetes.

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Personalized Nutrition by Prediction of Glycemic Responses.

David Zeevi, Tal Korem, Niv Zmora … (2015)

Elevated postprandial blood glucose levels constitute a global epidemic and a major risk factor for prediabetes and type II diabetes, but existing dietary methods for controlling them have limited efficacy. Here, we continuously monitored week-long glucose levels in an 800-person cohort, measured responses to 46,898 meals, and found high variability in the response to identical meals, suggesting that universal dietary recommendations may have limited utility. We devised a machine-learning algorithm that integrates blood parameters, dietary habits, anthropometrics, physical activity, and gut microbiota measured in this cohort and showed that it accurately predicts personalized postprandial glycemic response to real-life meals. We validated these predictions in an independent 100-person cohort. Finally, a blinded randomized controlled dietary intervention based on this algorithm resulted in significantly lower postprandial responses and consistent alterations to gut microbiota configuration. Together, our results suggest that personalized diets may successfully modify elevated postprandial blood glucose and its metabolic consequences. VIDEO ABSTRACT.

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Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030

Christian Bommer, Vera Sagalova, Esther Heesemann … (2018)

Despite the importance of diabetes for global health, the future economic consequences of the disease remain opaque. We forecast the full global costs of diabetes in adults through the year 2030 and predict the economic consequences of diabetes if global targets under the Sustainable Development Goals (SDG) and World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 are met.

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Author and article information

Contributors

Richard M Bergenstal:

ORCID: https://orcid.org/0000-0002-9050-5584

Journal

Journal ID (nlm-ta): J Endocr Soc

Journal ID (iso-abbrev): J Endocr Soc

Journal ID (publisher-id): jes

Title: Journal of the Endocrine Society

Publisher: Oxford University Press (US )

ISSN (Electronic): 2472-1972

Publication date Collection: 01 April 2021

Publication date (Electronic): 02 February 2021

Publication date PMC-release: 02 February 2021

Volume: 5

Issue: 4

Electronic Location Identifier: bvab013

Affiliations

[1 ] International Diabetes Center, Park Nicollet and HealthPartners , Minneapolis, MN, USA

[2 ] Abbott , Sylmar, CA, USA

[3 ] Abbott Diabetes Care , Alameda, CA, USA

[4 ] University of Washington School of Medicine , Seattle, WA, USA

Author notes

Correspondence: Richard M. Bergenstal, MD, HealthPartners Institute, 3800 Park Nicollet Blvd., Minneapolis, MN 55416-2527, USA. Email: richard.bergenstal@ 123456parknicollet.com .

Author information

Richard M Bergenstal https://orcid.org/0000-0002-9050-5584

Article

Publisher ID: bvab013

DOI: 10.1210/jendso/bvab013

PMC ID: 7901259

PubMed ID: 33644623

SO-VID: a84398e1-9240-4011-a91c-a6e1c2810dc0

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Date received : 03 December 2020

Date: 25 January 2021

Date: 23 February 2021

Page count

Pages: 9

Funding

Funded by: Abbott Diabetes Care, DOI 10.13039/100011946;

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Flash CGM Is Associated With Reduced Diabetes Events and Hospitalizations in Insulin-Treated Type 2 Diabetes

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Abstract

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Most cited references 38

Economic Costs of Diabetes in the U.S. in 2017

Personalized Nutrition by Prediction of Glycemic Responses.

Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030

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