68-LB: Use of Real-Time CGM Is Associated with Fewer Hospitalizations Compared with SMBG in the Insulin-Treated Medicare Population

Abstract

The Centers for Medicare and Medicaid (CMS) only allows coverage of CGM for beneficiaries with diabetes who are treated with insulin, (insulin injections ≥3/day or insulin pumps) and is currently performing SMBG ≥4/day. We used data from CMS to assess the clinical impact of using real-time CGM (Dexcom G5) by comparing a cohort of Medicare beneficiaries who acquired a CGM device from July 2017 thru January 2018 (n=841) with a cohort of beneficiaries (n=224,484) who continued SMBG during the same period. This cohort includes beneficiaries identified as insulin-treated in 2009 and survived through 2017. Overall, SMBG was associated with 35% more hospitalizations than CGM (35.5% vs. 26.2%) and 52% more inpatient visits (0.70 vs. 0.46) over 6 months (both p <0.0001). Reductions were seen across all demographic variables except non-whites. (Table 1.) The ADA estimates the cost of inpatient hospitalizations and emergency services among diabetes adults age ≥65 years in 2017 was $48.5 billion. These data suggest that wider use of CGM among CMS beneficiaries with diabetes could significantly reduce these costs through reduced hospitalizations and inpatient visits, and that CMS coverage for CGM should be broader than the current narrow coverage policy criteria. Disclosure G. Puckrein: None. D.G. Marrero: None. C. Parkin: Consultant; Self; Abbott, CeQur Corporation, Dexcom, Inc., DreaMed Diabetes, Novo Nordisk Inc., Onduo, Roche Diabetes Care, Valeritas, Inc. G.J. Norman: Employee; Self; Dexcom, Inc. L. Xu: None. P.M. Lynch: Employee; Self; Dexcom, Inc. Stock/Shareholder; Self; Dexcom, Inc. B.T. Taylor: Employee; Self; Dexcom, Inc. Funding Dexcom, Inc.