Use of rtCGM by patients with T1DM is associated with lower health care costs, fewer hospital admissions, and better glycemic control.

Context Health inequity is often associated with race-ethnicity. Objective To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with Type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users to non-users. Design The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared to non-users by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist. Setting Community Patients or Other Participants Beneficiaries with T1D and at least one inpatient or two outpatient claims in a CY Intervention(s) Pump or CGM therapy, visit to an endocrinologist Main Outcome Measure(s) Diabetes-related technology use by race-ethnicity groups Results Between 2017 and 2019 CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was <5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019 57% of White patients used a pump compared to 33.1% of Black and 30.3% of Other patients (P<0.001). Black patients were more likely than White patients to be eligible due to disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P<0.001), whether using technology or not. Significant race-ethnicity differences (P<0.001) existed between technology users and non-users for all evaluated factors except visiting an endocrinologist. Conclusions Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.

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DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2-9% regardless of insurance type.

A245 objectives. Adult patients with type 2 diabetes mellitus (T2DM) newly initiating treatment between January 1, 2010, and December 31, 2011, with either saxagliptin or sitagliptin were identified. A 1:1 propensity-matched sample of saxagliptin and sitagliptin patients was created to reduce any potential confounding. Propensity scores were generated based on demographic characteristics, comorbidities, disease severity and treatment patterns before the index date. Patients were required to have ≥ 6 months of continuous eligibility before (baseline period) and after (followup period) treatment initiation. All outcomes were assessed based on an intent-totreat analysis in the 6-month follow-up period. Both overall and diabetes-specific charges were computed; breakdowns of medical and overall (medical plus pharmacy) charges were compared. Appropriate univariate statistical tests were applied to the propensity-matched sample to examine differences in resource utilization outcomes. Results: A total of 8,438 and 23,155 patients initiated treatment with saxagliptin and sitagliptin, respectively. After matching, each cohort consisted of 7,700 patients. Compared with sitagliptin, during the follow-up period, saxagliptin was associated with significantly lower (all p values ≤ 0.

Objectives: To compare the economic impact of using a durable versus disposable insulin pump over a 4-year period (i.e., the typical warranty period) in individuals with type 1 diabetes (T1D). Methods: This population-based, longitudinal analysis used a large repository of healthcare claims data were used to compare healthcare costs (in 2017 U.S. dollars) and utilization in individuals with T1D using durable pumps (N=2,013) to those using disposable pumps (N=642), before and after pump adoption. T-test was used to examine the between-group difference in pump-related costs, and a generalized linear model regression was used to estimate the difference-in-difference effect of pump type on other outcomes. Results: Mean pump-related costs over the 4-year period were $6,606 less for durable pump users versus disposable pump users (Figure; p<0.0001). Mean out-of-pocket pump-related costs for the same time period were $1,037 less for durable pump versus disposable pump users (p<0.0001). There were no statistically significant differences between durable and disposable pump users for any other variables studied (continuous glucose monitoring costs, insulin costs, inpatient costs, emergency room costs, outpatient costs, hospital admissions, or emergency room visits). Conclusions: Use of a durable versus disposable insulin pump is associated with significantly lower pump-related costs. Disclosure M. Shah: Employee; Self; Medtronic. C. Zhu: Employee; Self; Medtronic.

Objectives: The healthcare utilization benefits associated with insulin pump therapy compared to multiple daily injections (MDI) therapy are not well known. This study sought to compare the impact of using a durable insulin pump versus MDI therapy on healthcare utilization and A1C among individuals with type 1 diabetes (T1D). Methods: This population-based, longitudinal analysis used a large repository of healthcare claims data to compare diabetes-related and all-cause inpatient admissions (IP) and emergency room (ER) visits in individuals with T1D using durable pumps (N=1,286) versus MDI (N=3,854). The study period was June 1, 2017 to July 31, 2019. The study index date was assigned to the first date of pump use in the pump cohort and a random index date was assigned to the MDI cohort. Continuous insurance enrollment 1-year before and 1-year after adoption/index date was required. Generalized linear model regression was used to test the difference-in-difference effect of therapy type on rates of utilization and A1C. The U.S. Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicator (PQI) algorithm was used to define diabetes-related utilization. Results: Individuals on insulin pump therapy had a significant decrease in IP utilization compared to little change among individuals using MDI therapy (-41% vs. +3%, p=0.01), and similar decreases in ER utilization (-27% vs. -16%, p=0.64). Combining diabetes-related IP and ER utilization, individuals on insulin pump therapy experienced a decrease of 34% compared to decrease of 8% among those using MDI therapy (p= 0.02). Individuals on insulin pump therapy also experienced a larger decrease in A1C (-7% vs. -1%, p=<0.0001). Conclusions: Compared to MDI therapy, use of a durable insulin pump associated with a significantly smaller increase in diabetes-related healthcare utilization and A1C over time. Disclosure M. Shah: Employee; Self; Medtronic. C. Zhu: Employee; Self; Medtronic. K. Wherry: Employee; Self; Medtronic.