1-OR: Burden of Hypoglycemia in Medicare Advantage Beneficiaries with Type 2 Diabetes Not on Insulin Therapy

Abstract

In 2022, the Centers for Medicare & Medicaid Services released proposed changes to Medicare’s continuous glucose monitoring (CGM) coverage policy, making individuals with a history of problematic hypoglycemia eligible for CGM coverage, irrespective of insulin use. This study estimated the burden of hypoglycemia in Medicare Advantage (MA) beneficiaries with type 2 diabetes not on insulin therapy (T2D-NIT). We retrospectively analyzed US healthcare claims data using Optum’s Clinformatics® database. MA beneficiaries with T2D-NIT were identified in the 15 years from 2007 to 2021. Hypoglycemia-related encounters (HREs) were those accompanied by a hypoglycemia-specific ICD9/10 diagnosis code in any position on the claim. HREs following the first claim related to T2D were enumerated and classified by setting (ambulatory or inpatient/emergency department [ED]). MA beneficiaries with T2D-NIT included a study population of 2,708,762 individuals (53% female, 65.2% White) followed for an average of 5 years. HREs were identified in 19.4% (n=525,741) of individuals, of whom 15.8% (n=428,734) had ambulatory encounter(s) and 5.41% (n=146,454) had inpatient/ED encounter(s). Prior to the first HRE, 26.5% (n=142,918) were using a sulfonylurea (SU), 35.9% (n=193,677) had evidence of chronic kidney disease, and 11.5% (n=62,404) had chronic kidney disease and were using a SU. These findings show that HREs are prevalent in the T2D-NIT population and identify a large number of patients who may benefit from CGM. Since >80% of HREs occur in the ambulatory setting and >70% occur in patients not taking SUs, primary care providers should be aware of the latest eligibility criteria for Medicare’s coverage of CGM and not restrict CGM to SU users. The generalizability of these findings is limited to the data source and may not be representative of the overall MA T2D-NIT or Medicare fee-for-service populations. Disclosure K.Hannah: Employee; Dexcom, Inc. P.Nemlekar: Employee; Dexcom, Inc. J.S.Bushman: Employee; Dexcom, Inc. G.J.Norman: Employee; Dexcom, Inc. Funding Dexcom, Inc.