Rates and Correlates of Uptake of Continuous Glucose Monitors Among Adults with Type 2 Diabetes in Primary Care and Endocrinology Settings

Abstract

Background Clinical trials indicate continuous glucose monitor (CGM) use may benefit adults with type 2 diabetes, but CGM rates and correlates in real-world care settings are unknown. Objective We sought to ascertain prevalence and correlates of CGM use and to examine rates of new CGM prescriptions across clinic types and medication regimens. Design Retrospective cohort using electronic health records in a large academic medical center in the Southeastern US. Participants Adults with type 2 diabetes and a primary care or endocrinology visit during 2021. Main Measures Age, gender, race, ethnicity, insurance, clinic type, insulin regimen, hemoglobin A1c values, CGM prescriptions, and prescribing clinic type. Key Results Among 30,585 adults with type 2 diabetes, 13% had used a CGM. CGM users were younger and more had private health insurance ( p < .05) as compared to non-users; 72% of CGM users had an intensive insulin regimen, but 12% were not taking insulin. CGM users had higher hemoglobin A1c values (both most recent and most proximal to the first CGM prescription) than non-users. CGM users were more likely to receive endocrinology care than non-users, but 23% had only primary care visits in 2021. For each month in 2021, a mean of 90.5 (SD 12.5) people started using CGM. From 2020 to 2021, monthly rates of CGM prescriptions to new users grew 36% overall, but 125% in primary care. Most starting CGM in endocrinology had an intensive insulin regimen (82% vs. 49% starting in primary care), whereas 28% starting CGM in primary care were not using insulin (vs. 5% in endocrinology). Conclusion CGM uptake for type 2 diabetes is increasing rapidly, with most growth in primary care. These trends present opportunities for healthcare system adaptations to support CGM use and related workflows in primary care to support growth in uptake.

A probabilistic computation framework to estimate the dawn phenomenon in type 2 diabetes using continuous glucose monitoring

“…While CGMs are not yet part of routine care in individuals at risk for or with non-insulin-treated T2D, multiple studies point to their acceptability, growing use, and potential benefits in this population 18 – 23 . Notably, a recent study at a large medical center showed a 125% increase in CGM prescriptions in primary care setting between 2020 to 2021, with 28% of these new users not on insulin 24 . These data suggest more widespread adoption of CGM in the near future in our target cohort of individuals at risk for or with T2D not on insulin, which makes real-world implementation of our probabilistic dawn phenomenon approach more feasible.…”

Technology and health inequities in diabetes care: How do we widen access to underserved populations and utilize technology to improve outcomes for all?

“…Data from centers for medicare & medicaid services have demonstrated that Black and Hispanic/Latino adults with T2D are prescribed CGM at lower rates than White adults 88 . In a study of CGM use in T2D at a large academic medical centre, prescription of CGM was associated with younger age, private insurance, basal‐bolus insulin use, endocrinologist visits, and higher HbA1c levels 89 . Similarly, younger age and endocrinologist visits have been associated with greater likelihood of insulin pump initiation in T2D 90 .…”

“… 88 In a study of CGM use in T2D at a large academic medical centre, prescription of CGM was associated with younger age, private insurance, basal-bolus insulin use, endocrinologist visits, and higher HbA1c levels. 89 Similarly, younger age and endocrinologist visits have been associated with greater likelihood of insulin pump initiation in T2D. 90 Recommendation: Both HCL systems and SIPs are currently understudied in T2D, and additional research on inequities in use and how the use of these devices may improve disparities in outcomes is necessary.…”