CGM Cuts Hospitalization in T2D, Even in Non-Insulin Treated

MADRID — The use of continuous glucose monitoring (CGM) reduced the risk for hospitalization and improved glucose control in people with type 2 diabetes, regardless of insulin use, a new analysis of real-world data found.

The data were presented at the European Association for the Study of Diabetes (EASD) 2024 Annual Meeting and simultaneously published in Diabetes, Obesity and Metabolism. The data on hospitalizations and A1c lowering were presented separately at EASD by two of the study investigators, Satish K. Garg, MD, professor of medicine and director of the Adult Diabetes Program at the Barbara Davis Center, University of Colorado, Aurora, Colorado, and Richard M. Bergenstal, MD, executive director of the International Diabetes Center of HealthPartners Institute, Minneapolis.

The advantages of CGM have been established for people with type 1 diabetes and those with type 2 who require multiple daily insulin doses and others who are at a risk for hypoglycemia (such as those using sulfonylureas). In the United States, Medicare and other payers typically cover the devices for those groups but not others with diabetes. Data on the impact of CGM use on others with diabetes who don’t use insulin and are not at increased hypoglycemia risk have been limited to studies with small sample sizes. In contrast, this new study used Optum’s de-identified Market Clarity data of more than 79 million people, the authors said in their paper.

Overall, similar reductions were seen in hospitalizations and glucose-lowering benefits from CGM in people who were not using insulin, those using only basal insulin, and those using multiple daily insulin doses. “CGM is one therapy that’s going to keep people from going into the hospital and improve their overall care, period. The data are pretty strong,” Garg told Medscape Medical News in an interview. 

Bergenstal pointed out that CGM can help people see the effects of diet and exercise on their blood sugar levels and act on the information. “Lifestyle changes are important and really do make a difference. They’re just so hard, but with CGM, people are making changes.”

Asked to comment, Charles Alexander, MD, an endocrinologist who previously worked for Merck and is now a medical and science advisor to diaTribe, told Medscape Medical News, “I think this really shows the value of CGM, regardless what you’re using to treat the glucose. While it might be thought that people who are not on insulin don’t need CGM, these data clearly show the benefit, regardless whether you’re getting insulin before meals, basal insulin, or medications that are not insulin.”

There are likely several mechanisms for the benefit in non-insulin users, Alexander said. “If they’re on sulfonylureas, then they may be able to avoid hypoglycemia. If they’re not using sulfonylurea or medicine that causes hypoglycemia, it may be related to the fact that they understand when their blood sugar is too high and they’re able to do something about it…The biggest problem with A1c is that it’s not actionable because you don’t know what the A1c is now, just what it used to be. That’s the value of CGM that you have an immediate understanding of what your blood sugar’s doing.”

Real-World Data Show Reductions in Hospitalization, A1c in All Treatment Groups

The study included 74,679 people with type 2 diabetes who initiated CGM, divided into three treatment groups: 25,269 did not use insulin, 16,264 used basal insulin only, and 33,146 used premeal and basal insulin. Their data were analyzed for the 6 months prior to their first CGM claim and for 12 months after.

Garg presented the hospitalization data. There were 14,147 all-cause hospitalizations during the 6-month pre-CGM period. That number dropped significantly at both timepoints, by 23.1% at 6 months and 18.8% at 12 months. Acute diabetes–related hospitalizations, including hypoglycemia, hypoglycemic coma, clinical hyperglycemia, diabetic ketoacidosis, and hyperosmolarity, dropped similarly at the two timepoints, by 52.5% and 49.5%, respectively. Acute diabetes–related events requiring emergency room visits also dropped, by 35.5% and 34.4%, respectively.

These reductions were similar in all treatment groups. At 12 months, all-cause hospitalizations were 10.1% lower for those treated with non-insulin (P < .0001), 13.9% lower for those treated with basal insulin–treated (P < .0001), and 22.6% lower for those treated with prandial insulin (P = .0025). Reductions at 12 months were even greater for acute diabetes–related hospitalizations, 31.0% (P < .0001), 47.6% (P < .0001), and 52.7% (P < .0001), respectively. 

In acute diabetes–related events requiring emergency room visits, reductions at 12 months were 30.7% (P < .0001), 28.2% (P < .0001), and 36.6% (P < .0001) for the three treatment groups, respectively. 

Bergenstal presented a subgroup analysis of 6030 individuals who had at least one A1c measurement in the pre-CGM and at the 6- and 12-month CGM-wearing timeframe. Baseline A1c values were 8.6% for the 1533 not on insulin, 9.0% for the 1375 on basal insulin, and 8.9% for the 3122 on multiple daily insulin doses. By 12 months, those values had dropped to 7.5%, 7.9%, and 8.0%, respectively. All three changes were statistically significant, with P < .0001. 

Overall, 23.4% achieved an A1c below 7.0%, with the greatest proportion, 32.0%, seen in the non-insulin–treated group. 

Will Wider CGM Use Save Money?

In their paper, Garg, Bergenstal, and colleagues cited data showing that the per capita cost associated with inpatient days among people with diabetes is five times higher than that for those without diabetes ($5668 vs $1138). 

In his presentation, Bergenstal said that the team plans to release more data soon that could inform a cost analysis. He noted that once all the data are published, the American Diabetes Association is likely to take them into account in their next Standards of Medical Care in Diabetes, which might then influence coverage decisions. 

Alexander commented, “If you look at it from a health economic point of view…I would think that [the upcoming data] would show that CGM saves money by reducing hospitalizations…It’s clear that the more data we can generate to show the value of CGM, the more willing insurers will be to pay for it.”

Garg is on advisory boards for, received consulting fees from, and/or received research grants from Medtronic, Novo Nordisk, Roche Diagnostics, Know Labs, Eli Lilly, Dario, Diasome, and Dexcom. He does not own stock in any device or pharmaceutical company. Bergenstal had no personal financial disclosures. His employer contracted for his services, and he received no personal income from his participation in clinical research, scientific board, and consultation for Abbott Diabetes Care, Ascensia, Bigfoot Biomedical Inc., CeQur, Dexcom, Eli Lilly, Embecta, Hygieia, Insulet, Medtronic, NCQA, Novo Nordisk, Onduo, Roche Diabetes Care, Sanofi, UnitedHealthcare, Vertex Pharmaceuticals, and Zealand Pharma. Alexander had no disclosures.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape Medical News, with other work appearing in the Washington Post, NPR’s Shots blog, and diaTribe. She is on X: @MiriamETucker.