Fully subsidized CGM in Australia drives ‘rapid’ uptake, improved glycemic outcomes
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Universal funding of continuous glucose monitoring for children and adolescents in Australia led to rapid device uptake and continued use for most, as well as sustained improvements in HbA1c and other glycemic measures, registry data show.
In April 2017, the Australian government fully funded CGM products for children and adolescents with type 1 diabetes through age 21 years through a national scheme, Stephanie R. Johnson, MD, a pediatric endocrinologist at Queensland Children’s Hospital in Brisbane, Australia, and colleagues wrote in the study background. Before funding, the use rate of CGM in Australia was 5% nationally.
“This sudden change in availability provided a unique opportunity to examine the real-world effect of the introduction of fully subsidized CGM available to a whole population,” Johnson and colleagues wrote. “Because the funding was universal, the effect of socioeconomic status was potentially reduced. The aim of this study was to evaluate the effect of the policy change on the rate of uptake and ongoing use of the devices and the impact, if any, on glycemic control and hypoglycemia and ketoacidosis rates, information of importance to funders, policymakers, clinicians and people living with type 1 diabetes.”
Researchers analyzed longitudinal data from 12 months before the subsidy until 24 months after, assessing patients’ age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycemia, insulin regimen, CGM uptake and percentage of CGM use. The researchers used data from the Australasian Diabetes Database Network (ADDN) registry, a prospective diabetes database, and the National Diabetes Services Scheme (NDSS) registry that includes almost all people with type 1 diabetes nationally.
The findings were published in Diabetes Care.
Researchers found that CGM uptake increased from 5% pre-subsidy to 79% after 2 years. Compared with CGM users, those choosing not to use CGM were older, had longer duration of diabetes, were more likely to be using a multiple daily injections regimen, and had higher baseline HbA1c.
After CGM introduction, OR for achieving the HbA1c target of less than 7% improved at 12 months (OR = 2.49; 95% CI, 2.13-2.9) and was maintained at 24 months (OR = 2.3; 95% CI, 1.93-2.75). The OR for suboptimal glycemic control, defined as an HbA1c of at least 9%, decreased to 0.34 (95% CI, 0.3-0.39) at 24 months.
Of CGM users, 65% used CGM at least 75% of time and had a lower HbA1c at 24 months compared with those with use less than 25% of the time (mean HbA1c, 7.8% vs. 8.6%; P < .001). DKA incidence was also reduced among this group, with an incidence rate ratio of 0.49 (95% CI, 0.33-0.74).
“If CGM is affordable, most people with type 1 diabetes will use the technology and see benefit,” Tim Jones, MD, professor at Perth Children’s Hospital and Telethon Kids Institute, Western Australia, told Healio. “The use of CGM is associated with improved glycemic outcomes. Also, policy makers and funders may be encouraged to fund CGM equitably.”
Jones noted that the likelihood of achieving the internationally defined target HbA1c of less than 7% increased more than twofold from baseline among CGM users, and the mean HbA1c was reduced by 0.3% to 0.5% overall.
“There are many questions,” Jones said. “We need to know why some people benefit more than others, why the minority who do not use CGM do not do so and how that can be changed, how to teach people to get the most out of CGM, and the economic benefits that will justify the costs.”
For more information:
Tim Jones, MD, can be reached at tim.jones@health.wa.gov.au.
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