Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes

Datye, Karishma A.; Tilden, Daniel R.; Parmar, Angelee M; Goethals, Eveline R.; Jaser, Sarah S.

doi:10.1007/s11892-021-01389-1

Cited by 18 publications

(13 citation statements)

References 55 publications

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“…We believe this analysis is a conservative estimate of the cost savings regarding the fnancial implications of rtCGM use. Tese fndings are consistent with previous research reporting that CGM alone signifcantly improves diabetes-related clinical outcomes and overall health care costs [1,7,17,22,23].…”

Section: Discussionsupporting

confidence: 88%

“…Te ADA frst recommended CGM use for all children and adolescents with T1D in 2018 [12] and continues to endorse this recommendation [13]. However, despite CGM now being accepted in global standards of care [14,15], it is still underutilized in AYA for a multitude of reasons, including device intricacies, costprohibitive access, or various social determinants of health and related disparities [16][17][18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c

et al. 2023

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Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benefits of rtCGM use in a high-risk, under-resourced cohort of adolescents and young adults (AYA) with type 1 diabetes (T1D) who had no prior access to rtCGM. The effects of rtCGM use on hemoglobin A1c (A1c) and the frequency of health care events (i.e., diabetes-related emergency room (ER) visits, hospitalizations, emergency medical services (EMS), and after-hour emergency calls) were evaluated regarding payor costs in 33 AYA with ≥70% rtCGM use. Secondary aims included the evaluation of a phone-based pattern management intervention. The frequency of health care events decreased at 12 and 24 weeks for all participants, and there was no significant difference by treatment group. We estimated that the use of rtCGM in this cohort results in a projected annualized cost-savings of $195,943 to $294,864 or 43–65% per year based on Medicare or list pricing for rtCGM, respectively. Results also revealed improvements in A1c at 12 weeks for all study participants, but this was not maintained at 24 weeks for the phone-based pattern management intervention group. Our findings suggest that rtCGM may be an effective tool for reducing diabetes-related events and underscores the importance of access. Future studies are needed to further examine tailored interventions and support to optimize rtCGM use and glycemic health in high-risk AYA.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c

et al. 2023

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“…Continuous glucose monitoring (CGM) provides serial interstitial glucose measurements in a noninvasive manner through a wearable device called a continuous glucose monitor (1-3). An advantage of continuous glucose monitoring is to have real time information about glycemic excursions that can be aligned with activities of daily living to support glycemic control among individuals living with diabetes (2)(3)(4). Various CGM are approved by the U.S Food and Drug Administration (FDA) for use in youth with diabetes, however little is known about the role and utility of CGM in the management of youth with obesity without diabetes (5).…”

Section: Introductionmentioning

confidence: 99%

“…While there was a wide variety of CGM uses and outcome metrics in adults, there were very few studies conducted in pediatric populations (5). Only eight studies in children and adolescents were identified, and all were relatively small (n = 17-118) and of very short duration (range of CGM wear = one to eight days) (3)(4)(5)(6)(7)(8). When considering the use of CGM in adolescents without diabetes, many factors must be considered including the feasibility and acceptability of daily wear and the selection of metrics extracted from CGM.…”

Section: Introductionmentioning

confidence: 99%

Continuous Glucose Monitoring in Adolescents With Obesity: Monitoring of Glucose Profiles, Glycemic Excursions, and Adherence to Time Restricted Eating Programs

et al. 2022

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BackgroundRandomized controlled trials of time restricted eating (TRE) in adults have demonstrated improvements in glucose variability as captured by continuous glucose monitors (CGM). However, little is known about the feasibility of CGM use in TRE interventions in adolescents, or the expected changes in glycemic profiles in response to changes in meal-timing. As part of a pilot trial of TRE in adolescents with obesity, this study aimed to 1) assess the feasibility of CGM use, 2) describe baseline glycemic profiles in adolescents with obesity, without diabetes, and 3) compare the difference between glycemic profiles in groups practicing TRE versus control.MethodsThis study leverages data from a 12-week pilot trial (ClinicalTrials.gov Identifier: NCT03954223) of late TRE in adolescents with obesity compared to a prolonged eating window. Feasibility of CGM use was assessed by monitoring 1) the percent wear time of the CGM and 2) responses to satisfaction questionnaires. A computation of summary measures of all glycemic data prior to randomization was done using EasyGV and R. Repeat measures analysis was conducted to assess the change in glycemic variability over time between groups. Review of CGM tracings during periods of 24-hour dietary recall was utilized to describe glycemic excursions.ResultsFifty participants were enrolled in the study and 43 had CGM and dietary recall data available (16.4 + 1.3 years, 64% female, 64% Hispanic, 74% public insurance). There was high adherence to daily CGM wear (96.4%) without negative impacts on daily functioning. There was no significant change in the glycemic variability as measured by standard deviation, mean amplitude glycemic excursion, and glucose area under the curve over the study period between groups.ConclusionsCGM use appears to be a feasible and acceptable tool to monitor glycemic profiles in adolescents with obesity and may be a helpful strategy to confirm TRE dosage by capturing glycemic excursions compared to self-reported meal timing. There was no effect of TRE on glucose profiles in this study. Further research is needed to investigate how TRE impacts glycemic variability in this age group and to explore if timing of eating window effects these findings.

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“…Young adulthood is a high-risk time for T1D management (American Diabetes Association, 2021b), as young adults with T1D have higher glycated hemoglobin levels (average glucose over 2–3 months) than any other age group, have greater diabetes distress than those over 30, they experience T1D complications at a high rate (Dabelea et al, 2017; Iyengar et al, 2019), and they experience more frequent hospital visits (McCarthy & Grey, 2018; Vallis et al, 2018; Wysocki et al, 1996). Young adults are also less likely to use recent technologies effectively (Datye et al, 2021) including continuous glucose monitoring (CGM) devices that provide greater control of glucose levels (Garg et al, 2007). In the current study, we define young adulthood as 18–37 years of age, which is similar to other studies of young people with T1D (see Aina-Popoola, 2017; Helgeson, 2017).…”

mentioning

confidence: 99%

Communal coping and glycemic control: Daily patterns among young adult couples with type 1 diabetes.

Yorgason,

Noorda,

Steeger

et al. 2024

Families, Systems, & Health

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Introduction: Young adulthood is a time when persons with Type 1 diabetes (T1D) become more fully responsible for diabetes management. Establishing healthy diabetes routines during this period is foundational for successful management across adulthood. Although partner support is generally considered helpful in T1D management, less is known about specific partner behaviors that could benefit glucose levels. The aim of this study was to explore associations between communal coping behaviors and T1D glucose management. Method: During 2018-2020, 23 young married opposite-sex couples (M age = 25.7 years), wherein one spouse had T1D, completed daily measures of communal coping for 9 consecutive days. Daily average glucose and time-in-range were computed from the person with T1D's glucose meter or continuous glucose monitor. Results: Multilevel model results suggested that higher time-in-range on a given day was predicted by reports of lower daily spousal instrumental support, lower overprotective and controlling behaviors, and by higher emotional support. Controlling spousal behavior on one day was associated with higher time-in-range the next day. At the same time, patient reports of higher average spousal controlling behavior (across all days) were associated with lower time-in-range and higher average glucose. Average glucose was also predicted by communal coping behaviors (especially within-person higher instrumental support), yet results were less robust after covariates were considered. Discussion: Some young romantic partners may engage in behaviors that are associated with higher average blood glucose and lower time-in-range for the person with T1D. Persons with T1D could communicate to their partners types of support that are helpful versus not. Public Significance StatementThis study advances the role of communal coping behaviors between young adults with Type 1 diabetes (T1D) and their romantic partner related to diabetes management. Support provided to young adults with T1D from their partners was associated with average glucose levels and time-in-range, which suggests that interventions that include partners to direct support efforts toward more beneficial forms of support may facilitate diabetes management. Jeremy B. Yorgason https://orcid.org/0000-0002-4208-7306 Jeremy B. Yorgason served as lead for conceptualization, formal analysis, investigation, and writing-original draft. Naomi M. Noorda contributed equally to visualization and served in a supporting role for formal analysis and writing-original draft. Danielle Steeger served in a supporting role for investigation and writing-original draft. Jennifer Saylor served in a supporting role for conceptualization and writing-original draft. Cynthia Berg served in a supporting role for conceptualization and writing-original draft. Adam Davey served in a supporting role for conceptualization and writing-original draft. Susannah Rellaford served in a supporting role for conceptualization and investigation. Daylee Kirkham served in a supporting role for writi...

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Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes

Cited by 18 publications

References 55 publications

Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c

Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c

Continuous Glucose Monitoring in Adolescents With Obesity: Monitoring of Glucose Profiles, Glycemic Excursions, and Adherence to Time Restricted Eating Programs

Communal coping and glycemic control: Daily patterns among young adult couples with type 1 diabetes.

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