Diabetes Increases Cardiovascular Risk
In the United States, approximately 34.2 million people of all ages have Type 1 or Type 2 diabetes mellitus, and the prevalence of this diagnosis continues to increase annually. Patients who achieve glucose control have a lower risk of acute complications, yet only half of patients with diabetes are able to achieve this control with a hemoglobin A1c (HbA1c) less than 7%. Even just a 1% increase in HbA1c is associated with a 40% increase in cardiovascular or ischemic heart disease mortality.[1,2] Additionally, diabetes-related comorbidities substantially increase healthcare utilization, with the cost of diabetes in the United States totaling around $254 billion in 2012.[2,3]
Continuous Glucose Monitors Reduce Barriers to Testing and Improve Glucose Control
Traditionally, achieving blood glucose control require patients to check their blood sugar with finger sticks multiple times a day. CGM has radically changed the treatment of diabetes by reducing this barrier through the use of a sensor embedded under the skin which provides a constant measure of interstitial glucose levels. CGM technology allows patients to not only receive a point in time glucose level, but also tracks glucose patterns over time. This increases patients’ understanding of their glucose trends and how to adjust their insulin levels accordingly. The most recent CGM technology, like Dexcom G6, sends glucose readings to a smart device every five minutes allowing patients to receive real time alerts on high and low blood glucose readings.[4]
A major hesitation for patients to initiate or remain adherent with insulin therapy is the fear associated with hypoglycemia. Recent evidence suggests that consistent CGM use may play a role in the reduction of fear associated with hypoglycemia. Additionally, a recent study showed that patients with type 2 diabetes who use insulin therapy, that used CGM, had a significantly lower chance of all-cause inpatient hospitalizations compared to patients that used the more traditional method of glucose monitoring. This reduction in hospitalization can result in a decrease in overall healthcare costs.
Benefit Expansion Creates Opportunity to Study CGM Impact
While large clinical trials show that use of CGM can improve glycemic control in insulin-treated patients with diabetes, the cost of these systems can often result in significant patient access issues. From the payer’s perspective, the cost of these systems may be offset by subsequent reductions in healthcare spending as patients’ management of diabetes improves. In December of 2018, Blue Cross Blue Shield of North Carolina updated the formulary and expanded access to these therapies. This expanded access will allow for further research regarding the difference in the two types of CGM systems available. Using administrative claims data from Blue Cross Blue Shield of North Carolina we aim to: 1) describe the change in use of CGM following the benefit expansion, and 2) determine the impact of CGM initiation on healthcare spending and utilization. The long-term goal of this research is to improve healthcare quality for patients with diabetes. The result of this research will inform coverage decisions for CGM, as well as provide vital information for clinicians and patients considering the use of these glucose monitoring systems.
- Navarro-Pérez J, Orozco-Beltran D, Gil-Guillen V, Pallares V, Valls F, Fernandez A, Perez-Navarro AM, Sanchis C, Dominguez-Lucas A, Martin-Moreno JM, Redon J, Tellez-Plaza M; ESCARVAL STUDY GROUP. Mortality and cardiovascular disease burden of uncontrolled diabetes in a registry-based cohort: the ESCARVAL-risk study. BMC Cardiovasc Disord. 2018 Sep 4;18(1):180.
- Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016 Jul 3;11:95-104.
- Struijs JN, Baan CA, Schellevis FG, Westert GP, van den Bos GA. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res. 2006 Jul 4;6:84.
- Miller EM. Using Continuous Glucose Monitoring in Clinical Practice. Clin Diabetes. 2020 Dec;38(5):429-438.