Sustained CGM Use in Low Income Youth following Insurance Coverage

Abstract

California Children’s Services (CCS) is a supplemental state medical insurance for low income children with chronic medical conditions. Until June 2016, continuous glucose monitors (CGM) were rarely covered by CCS for children with type 1 diabetes (T1D). Current CCS criteria for CGM includes: checking blood sugar 4 times/day and concerns that interfere with T1D management (such as fear of hypoglycemia). Ongoing approval requires CGM use for 5/7 days/week. We evaluated 6 months of CGM use by the first 41 children approved by CCS attending our clinics (age= 11.1 ± 4.7 years [range 3-21 years], T1D duration=4.8 ± 3.7 years, 59% male, 66% on pumps, 63% ethnic minorities and 15% non-English speakers). Most patients used the Dexcom receiver (73%). Thirty-three (81%) remained on CGM for ≥6 months. Of the 8 who stopped, 2 were due to lapses in insurance coverage. The other 6 stopped due to personal preference (5 within 3 months). All who stopped CGM use were English speakers. Among those who continued CGM with complete data (n=29, 71%), the mean percentage time worn at 6 months was 97±8% based on review of the CGM download. HbA1c remained stable over 6 months of CGM use (8.2±1.2%). Blinded CGM use was not available prior to initiation of personal CGM, so we cannot assess if hypoglycemia decreased. However, many of these children with CCS started CGM due to hypoglycemia and/or fear of hypoglycemia. Time in hypoglycemia as low at 6 months (4.3±4.8%). The number of fingersticks remained stable with 6.3/d at initiation and 5.6/d at 6 months. Our clinic data from the first 41 CCS patients approved for CGM demonstrates sustained CGM use for 6 months, even among non-English speakers. In this initial chart review, the incidence of hypoglycemia is low while on CGM. These data on sustained usability of CGM support CCS coverage of CGM. Given FDA approval of CGM use for insulin dosing decisions, expansion of CCS coverage of CGM should be considered to improve bolus adherence. Further studies are needed to promote improved clinical use and outcomes with CGM in this population. Disclosure P. Prahalad: None. B. Buckingham: Advisory Panel; Self; Novo Nordisk Inc., ConvaTec Inc.. Research Support; Self; Medtronic, Insulet Corporation, Dexcom, Inc., Tandem Diabetes Care, Inc.. Consultant; Self; Tandem Diabetes Care, Inc., Becton, Dickinson and Company. D. Wilson: Research Support; Self; T1D Exchange, Medtronic MiniMed, Inc., Dexcom, Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Insulet Corporation. Advisory Panel; Self; Tolerion. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions.