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Real-time CGM reimbursement improves glycemic control in type 1 diabetes
Real-time continuous glucose monitoring improves HbA1c, reduces hospitalizations for severe hypoglycemia or ketoacidosis and elevates quality of life in adults with type 1 diabetes on insulin pump therapy, study data show.
Pieter Gillard, MD, PhD, assistant head of clinic in the department of endocrinology at University Hospitals Leuven and associate professor at the University of Leuven in Belgium, evaluated data from the RESCUE trial on 515 adults (59% women; 97% white; mean age, 42.2 years) with type 1 diabetes (mean diabetes duration, 22.3 years) on continuous subcutaneous insulin infusion (mean duration of insulin pump use, 5.7 years) starting in the Belgium real-time CGM reimbursement program between September 2014 and December 2016. Researchers sought to determine the effect of real-time CGM in a real-world setting on glycemic control, hospital admissions, work absenteeism and quality of life over 12 months.
The Belgian health care authority authorized reimbursement of real-time CGM for type 1 diabetes among patients using insulin pumps and being treated in selected specialized diabetes centers in September 2014. Seventeen centers were selected based on sufficient experience with continuous subcutaneous insulin infusion ( 50 patients on insulin pump therapy).
“Within a strict budget, diabetes specialists of one of the 17 specialized centers were free in selecting patients with type 1 diabetes on continuous subcutaneous insulin infusion therapy,” Gillard told Endocrine Today. “This made it possible to select motivated patients who they believed would benefit the most from real-time CGM. It shows that CGM reimbursement in the right patient population using real-time CGM more than 70% of the time has positive effects on glycemic control, quality of life, hospital admissions for acute diabetes complications and work absenteeism. Our findings thus support the benefit of real-time CGM under real-world conditions.”
HbA1c decreased from 7.7% at baseline to 7.4% at 12 months (P < .0001) in the total population. HbA1c decreased from 8.2% before reimbursement to 7.6% after 12 months in participants using real-time CGM because of insufficient and variable glycemic control (P < .0001); the decrease in HbA1c was lower, from 7.5% to 7.4%, in participants using real-time CGM because of hypoglycemia. Baseline HbA1c was lowest in women using real-time CGM because of ongoing or planned pregnancy (7.2%), and HbA1c decreased to 6.6% at 4 months and to 6.9% at 12 months.
In the year before real-time CGM initiation, 16% of participants were admitted to the ED or hospital for severe hypoglycemia and/or ketoacidosis, which fell to 4% during the year in the reimbursement program (P < .0005). Participants who reported diabetes-related absenteeism decreased from 123 participants to 36 participants over the 12 months (P < .001), and the number of days reported absent also decreased from 495 days per 100 patient-years to 234 days per 100 patient-years after 12 months (P = .001).
Among all participants, physical functions, role-physical, bodily pain, general health, vitality, social functioning, role-emotional and mental health were all improved over the 12 months as reported by participants through the SF-36 questionnaire.
“Within the restraints of a real-world study, we believe that [the] data are sound due to the high quality of the database containing all patients that receive real-time CGM reimbursement in Belgium,” Gillard said. “Many health care decision-makers are developing policies that integrate evidence from different sources, including real-world data that contribute in important ways to the evidence base (eg, demonstrating how real-time CGM benefits patients with type 1 diabetes followed in specialized centers).” – by Amber Cox
For more information:
Pieter Gillard, MD, PhD, can be reached at pieter.gillard@uzleuven.be.
Disclosures: The authors report no relevant financial disclosures.