CGM use lowers hospitalizations, may reduce mortality in type 1 and type 2 diabetes
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Use of continuous glucose monitoring was associated with improved glycemic control and a lower risk for hospitalization in adults with type 1 and type 2 diabetes attending Veterans Affairs clinics in the U.S., according to a speaker.
During a presentation at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease, Peter Reaven, MD, professor in the division of endocrinology at the University of Arizona College of Medicine and endocrinologist at the Carl T. Hayden VA Medical Center in Phoenix, discussed how CGM can confer benefits for people with diabetes beyond lowering HbA1c, such as a reduced risk for hypoglycemia, hyperglycemia and hospitalizations.
“There may be many benefits from use of CGM in addition to glucose control, as it may have meaningful effects on complications,” Reaven said during a presentation. “All of these data suggests that we may need to look at occurrence of these types of outcomes in a much more serious fashion, because there may be some additional benefits that we didn’t anticipate. If true, then CGM use may need to become more like the SGLT2 inhibitors, and we’ll start using them not only to lower glucose, but to also reduce clinical outcomes.”
Reaven and colleagues collected data from across the U.S. using VA electronic health records. Adults with either type 1 or type 2 diabetes who used insulin, had at least one outpatient primary care, endocrinology or diabetes clinic visit in the year prior to data collection, had at least 2 years of VA data available and had follow-up data recorded were included. Adults were defined as new CGM users if they had at least one glucose sensor prescription with the first fill date from 2015 to 2020. Non-CGM users were adults with the same general inclusion criteria who used only glucose strips. Researchers compared the change in HbA1c, hospitalizations related to hypoglycemia and hyperglycemia, all-cause hospitalization and other outcomes between CGM users and non-CGM users at 12 months. Differences in relevant variables between CGM and non-CGM users were balanced using propensity score overlap weighting.
CGM use linked to lower hospitalization risk
The cohort included 5,015 adults with type 1 diabetes using CGM, 3,518 people with type 1 diabetes not using CGM, 15,706 adults with type 2 diabetes using CGM and 29,912 individuals with type 2 diabetes not using CGM.
At 12 months, CGM users with type 1 diabetes had a greater decline in HbA1c at 12 months compared with non-CGM users (mean difference, –0.26; 95% CI, –0.31 to –0.21; P < .001). Similarly, CGM users with type 2 diabetes had a greater HbA1c reduction at 12 months than non-CGM users (mean difference, –0.39; 95% CI, –0.42 to –0.36; P < .001).
“When looking at subsets of individuals to see if some groups of individuals might gain even greater benefit, we found in general that there were greater reductions in HbA1c in younger individuals, those with higher HbA1c at baseline and those who used their CGM more consistently over 12 months of follow-up in type 1 diabetes patients,” Reaven said. “The same pattern was seen with type 2 diabetes, with even greater effects seen in younger individuals, those with higher HbA1c at baseline or those who use their CGM more consistently.”
Adults with type 1 diabetes using CGM also had a lower risk for admissions to emergency rooms or hospitals for hypoglycemia-related events (HR = 0.69 95% CI, 0.48, 0.98; P = .04), or hypoglycemia events as defined by either of these types of admissions or having an outpatient glucose level of less than 54 mg/dL (HR = 0.72; 95% CI, 0.57-0.91; P = .01) and all-cause hospitalization (HR = 0.75; 95% CI, 0.63-0.9; P = .002) than non-users, but there was no difference in hyperglycemia risk. Adults with type 2 diabetes using CGM had a lower risk for hyperglycemia events (HR = 0.87; 95% CI, 0.77-0.99; P = .04) and all-cause hospitalization (HR = 0.89; 95% CI, 0.82-0.97; P = .004) than non-users with type 2 diabetes, but hypoglycemia events did not differ between the two groups.
CGM use may lower risk for mortality
In a very preliminary assessment, the investigators also calculated mortality risk between CGM users and nonusers at 18 months. For these analyses, adults with particularly high mortality risk and conditions that make it less likely they may receive a CGM were excluded to further reduce potential bias. After propensity score overlap weighting, adults with type 1 diabetes using CGM had a lower risk for mortality at 18 months than non-CGM users (adjusted HR = 0.38; 95% CI, 0.28-0.51; P < .001). Similarly, CGM users with type 2 diabetes had a reduced mortality risk compared with non-users after propensity score overlap weighting was applied (aHR = 0.79; 95% CI, 0.7-0.88; P <.001). Reaven noted that although these recent results need to be more carefully assessed to confirm their validity, they certainly add to the interest and relevance of studying the effects of these devices on longer-term outcomes.
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Reaven P. Session 5: Effects of glucose monitoring in the VHA. Presented at: World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease; Dec. 1-3, 2022; Universal City, California (hybrid meeting).
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