Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial

Wan, Wen; Skandari, M. Reza; Minc, Alexa; Nathan, Aviva G.; Winn, Aaron N.; Zarei, Parmida; O’Grady, Michael J.; Huang, Elbert S.

doi:10.2337/dc17-1821

Cited by 78 publications

(67 citation statements)

References 42 publications

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“…In the Diamond study, a CGM system with twice-daily calibrations and a 7-day expected sensor lifespan was found to be cost-effective at a willingness-topay threshold of $100,000 per quality-adjusted life year. 18 Elimination of the calibration requirement and a 10-day expected sensor lifespan suggest favorable implications for the cost-effectiveness of the G6 system.…”

Section: Discussionmentioning

confidence: 99%

Performance of a Factory-Calibrated Real-Time Continuous Glucose Monitoring System Utilizing an Automated Sensor Applicator

Shah

Laffel

Wadwa

et al. 2018

Diabetes Technology & Therapeutics

137

124

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Section: Discussionmentioning

confidence: 99%

Performance of a Factory-Calibrated Real-Time Continuous Glucose Monitoring System Utilizing an Automated Sensor Applicator

Shah

Laffel

Wadwa

et al. 2018

Diabetes Technology & Therapeutics

137

124

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“…Continuous objective measurement technologies are of significant interest across the healthcare community for the potential to improve healthcare quality and efficiency as well as serve as a catalyst for accelerating the pace of innovation [36] [37] [38]. These technologies are driving a paradigm shift from sole use of in-clinic subjective measurements to in-home continuous monitoring during activities of daily living, a transformation in health care delivery of particular importance in prevalent, heterogeneous, and chronic disease states like diabetes, cardiovascular disease, and asthma [39] [40] [41] [42].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Clinical Utility of the Personal KinetiGraph<sup>&reg;</sup> in the Management of Parkinson Disease

Nahab¹,

Abu-Hussain²,

Moreno³

2019

APD

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INTRODUCTION: Parkinson's disease (PD) is a disorder characterized by complex motor and non-motor symptoms that can be difficult for patients to accurately communicate. Wearable technologies portend improvements in assessment and monitoring of these symptoms, with their clinical utility currently being evaluated in routine clinical care. OBJECTIVE: To evaluate the clinical utility of the Personal KinetiGraph® (PKG®) Movement Recording System in the routine clinical care of persons with PD (PWP). METHODS: Clinically stable, non-demented PWP presented for two routine clinic visits that included: medication review, symptom review, neurological examination including the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) III/IV, and completion of a clinical management plan by a movement disorder specialist prior to review of the PKG report. After reviewing the PKG report, the clinician completed a modified clinical management plan taking into consideration the findings of the PKG. This was repeated at a second visit to evaluate various outcome measures following PKG-enhanced management. RESULTS: The PKG improved the assessment of PD symptoms and the response to treatment, while increasing patient activity levels and compliance. Clinical management plans enhanced by PKG led to different recommendations in 29.4% of cases compared with standard of care due to higher rates of bradykinesia, dyskinesia, tremor, and fluctuations identified by PKG. Using the PKG in the clinical management plan led to a change in medications in 75% (21/28) of patients and both a statistically significant difference and a clinically meaningful reduction in MDS-UPDRS III score of 4.8 (p = 0.028). Additionally, positive changes in both the clinician (17/28; 61%) and patient-reported (13/24; 54%) Global Impression of Improvement were reported. CONCLUSION: The PKG is a valuable tool in augmenting clinical management when utilized along with a clinical assessment.

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“…In contrast, most private insurers simply require annual paperwork requesting a CGM for initial and continued coverage of CGM.Similar to cost considerations reported for intermittently scanned CGM, CGM may be able to offset monthly costs of test strips thereby offering a potential cost neutral solution for broadening access while improving outcomes. [23][24][25] For those who were self-discontinuers, improvements in adhesives, customizable alarm thresholds, and factory calibration which obviate the need for fingerstick blood glucoses with newer generation CGM, may improve adherence and use of CGM technology.…”

mentioning

confidence: 99%

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

et al. 2020

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Objective: Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance. Methods: We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two-week CGM data were collected. Youth were classified as never user, consistent user, insurance discontinuer, and selfdiscontinuer. Visits were categorized as never-user visit, visit before CGM start, visit after CGM start, visit with continued CGM use, visit with initial loss of CGM, visit with continued loss of CGM, and visit where CGM is regained after loss. Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c. Results: Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start) was lower for visit after CGM start (−0.39%;[95%CI −0.78,−0.02]) and visit with continued CGM use (−0.29%;[95%CI −0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI −0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]). Conclusions: Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance. K E Y W O R D S diabetes technology, health policy, insurance, minority health, pediatric type 1 diabetes 1 | INTRODUCTION Optimal glucose control paired with improved quality of life is an important management goal for youth with type 1 diabetes (T1D) and providers who care for them. 1-3 Incorporation of continuous glucose This work was previously presented in a poster abstract form at the International Society for Pediatric and Adolescent Society's 45th Annual Conference.

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Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial

Abstract: For adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control, CGM is cost-effective at the willingness-to-pay threshold of $100,000 per QALY, with improved glucose control and reductions in nonsevere hypoglycemia.

Cited by 78 publications

References 42 publications

Performance of a Factory-Calibrated Real-Time Continuous Glucose Monitoring System Utilizing an Automated Sensor Applicator

Performance of a Factory-Calibrated Real-Time Continuous Glucose Monitoring System Utilizing an Automated Sensor Applicator

Evaluation of Clinical Utility of the Personal KinetiGraph<sup>&reg;</sup> in the Management of Parkinson Disease

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

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Cost-effectiveness of Continuous Glucose Monitoring for Adults With Type 1 Diabetes Compared With Self-Monitoring of Blood Glucose: The DIAMOND Randomized Trial

Abstract: For adults with T1D using multiple insulin injections and still experiencing suboptimal glycemic control, CGM is cost-effective at the willingness-to-pay threshold of $100,000 per QALY, with improved glucose control and reductions in nonsevere hypoglycemia.

Cited by 78 publications

References 42 publications

Performance of a Factory-Calibrated Real-Time Continuous Glucose Monitoring System Utilizing an Automated Sensor Applicator

Performance of a Factory-Calibrated Real-Time Continuous Glucose Monitoring System Utilizing an Automated Sensor Applicator

Evaluation of Clinical Utility of the Personal KinetiGraph&lt;sup&gt;&amp;reg;&lt;/sup&gt; in the Management of Parkinson Disease

Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance

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Evaluation of Clinical Utility of the Personal KinetiGraph<sup>®</sup> in the Management of Parkinson Disease