Year of Publication

2022

College

Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Mary E. Lacy

Committee Member

Dr. Daniela Moga

Committee Member

Dr. Anna Kucharska-Newton

Abstract

BACKGROUND: Continuous glucose monitoring (CGM) improves diabetes control by reducing HbA1c and decreasing rates of hypoglycemia. Despite clinical benefits and clear guidelines from the American Diabetes Association, <20% of patients with type 1 diabetes mellitus (T1DM) use CGM. Studies report disparities in CGM among youth with T1DM by race/ethnicity, socioeconomic status, and region, but, insight into patterns of CGM utilization in adults with T1D is limited. METHODS: This project retrospectively analyzed CGM utilization among individuals with T1DM age 18-64 using the Truven MarketScan® Commercial Claims and Encounters (CCAE) database from 1/1/2016-12/31/2018. CGM utilization was determined using National Drug Code (NDC), Current Procedural Terminology (CPT), or Healthcare Common Procedure Coding system II (HCPCS II) claim identifiers. Individuals with >365 days of continuous medical and pharmacy insurance eligibility were followed from their first Type 1 diabetes-related diagnosis code until the end of the study period or >120 day gap in coverage. Using descriptive statistical analysis, CGM utilization was examined in the overall population and was stratified by patient demographics (age, sex, region), and clinical characteristics (insulin pump, diabetes complications). As a secondary analysis, CGM utilization was further stratified by both calendar year and type of claim (i.e., pharmacy vs. medical). RESULTS: The CCAE database returned 174,809 eligible enrollees with T1DM from 2016-2018. 52,622(30.10%) had at least one claim for a CGM device and 122,187 (69.90%) did not. The average age of CGM users was younger than non-users [mean (SD) age, 41.77 (13.44) vs 47.93 (12.68), p < .0001]. The prevalence of CGM use was highest among those aged 18-24 (45.01%) and 25-34 (43.75%). CGM use was lowest in those aged 55-64 (19.37%). CONCLUSION: From this large, national cross-sectional analysis, it was estimated that less than one third of adults (18-64) with T1DM had utilized CGMs at any point between 2016-2018. Given the well-described clinical benefit of CGM devices in helping users to maintain glycemic levels within the desired range, further studies and guidance on the use of CGM in T1DM is clearly needed.

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