1121-P: Association between Self-Monitored Blood Glucose and Continuous Glucose Monitor in Youth with Type 1 Diabetes and Medicaid

Abstract

Background: In many states, patients with type 1 diabetes (T1D) and public insurance must demonstrate self-monitored blood glucose (SMBG) 3 times per day for continuous glucose monitor (CGM) approval. On January 2022, a policy change in California led to less stringent criteria for CGM approval, allowing for the evaluation of whether lower baseline SMBG leads to poor compliance and outcomes with CGM use. Method: We used electronical health record data of pediatric patients with T1D, Medicaid at UCLA who started CGM after January 2019. Patients were stratified by SMBG frequency (< 3 times per day vs ≥ 3 times per day). We used descriptive statistics to report baseline demographics, and chi-squared test, t-test and logistic regression to evaluate differences in compliance and change in A1c. Results: We found 52 patients who met the criteria - 52% with SMBG < 3 vs. 48% with SMBG ≥ 3. The patients were mostly male in both groups (63% vs. 60%). Patients with SMBG < 3 were older at time of T1D diagnosis (10 vs 6.2 years old), started CGM at older age (16.1 vs 11.7 years old), more likely to start CGM after January 2022 (82% vs 40%), and had higher baseline A1c (10.9% vs 9.0%). At 3 and 6 months after starting CGM, there was significantly greater reduction in A1c in those with SMBG <3 (1.6% vs 0.3%, p = 0.021, and 1.5% vs 0.23%, p = 0.01). There was no significant difference in CGM compliance (60% vs 72%, p = 0.21, and 69% vs 80%, p = 0.24, respectively) between the two groups. In adjusted models for 3 and 6 months, there were no significant association between CGM compliance (OR 1.04, 95%CI 0.68-1.60, and OR 1.06, 95%CI 0.76-1.28, respectively) and change in A1c. Conclusion: Patients with lower baseline SMBG had similar CGM compliance and greater improvement in A1c than patients with higher baseline SMBG. This suggests that restricting CGM approval to those who are adherent to SMBG ≥3 may exclude use in patients who would benefit the most from CGM technology. Larger studies are needed to confirm these findings. Disclosure J.Chan: None. J.K.Yee: None. T.Moin: None. E.M.Everett: None. Funding University of California, Los Angeles Children's Discovery and Innovation Institute (CDI-FRSA-07012022); National Center for Advancing Translational Sciences (UL1TR001881)