Initiation Of Continuous Glucose Monitoring Research Articles

Continuous Glucose Monitoring for Management of Type 2 Diabetes and Perinatal Outcomes.

To evaluate the association between continuous glucose monitoring in pregnant people with type 2 diabetes and perinatal outcomes. This was a retrospective cohort study of pregnant people with type 2 diabetes who received prenatal care and delivered singleton, nonanomalous neonates at a single academic tertiary care center from November 1, 2019, to February 28, 2023. The primary outcome was a composite of neonatal morbidity, including hypoglycemia, hyperbilirubinemia, shoulder dystocia, large for gestational age at birth, preterm birth, neonatal intensive care unit (NICU) admission, or perinatal death. Demographics and outcomes were compared by type of monitoring (continuous glucose monitoring vs intermittent self-monitoring of blood glucose), and multivariable logistic regression estimated the association between continuous glucose monitoring use and perinatal outcomes. Of 360 pregnant people who met the inclusion criteria, 82 (22.7%) used continuous glucose monitoring. The mean gestational age at continuous glucose monitoring initiation was 21.3±6.4 weeks. The use of continuous glucose monitoring was associated with lower odds of the primary composite neonatal morbidity (65.9% continuous glucose monitoring vs 77.0% self-monitoring of blood glucose, adjusted odds ratio [aOR] 0.48, 95% CI, 0.24-0.94). Continuous glucose monitoring use was also associated with lower odds of preterm birth (13.4% vs 25.2%, aOR 0.48, 95% CI, 0.25-0.93) and NICU admission (33.8% vs 47.6%, aOR 0.36, 95% CI, 0.16-0.81). In pregnant people with type 2 diabetes, continuous glucose monitoring use was associated with less neonatal morbidity, fewer preterm births, and fewer NICU admissions.

A Nutrition-Focused Approach During Continuous Glucose Monitoring Initiation in People With Type 2 Diabetes: Using a Theoretical Framework to Unite Continuous Glucose Monitoring and Food Choices.

Continuous glucose monitoring (CGM) has transformed diabetes care, yet opportunities for further innovations still exist. Some research suggests CGM could be an ideal tool to guide food choices and other healthy lifestyle behaviors, especially for people with type 2 diabetes (T2D). Behavior change theories can be used to understand and describe how CGM users make food-related decisions, which could ultimately lead to the design of more tailored and effective interventions. In this commentary, we describe what it looks like to use the behavior change wheel-a theory-based intervention development framework-to design an intervention for people with T2D who will use CGM data to guide food choices aligned with evidence-based nutrition recommendations. Such frameworks may be beneficial when designing or evaluating future technology-focused behavior change interventions.

Association of Fructosamine Levels With Glycemic Control in Children With Type 1 Diabetes as Determined by Continuous Glucose Monitoring: Results From the CGM TIME Trial

ObjectiveOur aim in this study was to determine the correlation between serum fructosamine and average blood glucose, as measured by continuous glucose monitoring (CGM) in children with type 1 diabetes. MethodsNinety-seven blood samples were collected from 70 participants in the Timing of Initiation of continuous glucose Monitoring in Established pediatric diabetes (CGM TIME) Trial. Each eligible participant had 3 weeks of CGM data with at least 60% CGM adherence before blood collection. Ordinary least-squares linear regression incorporating restricted cubic splines was used to determine the association between fructosamine levels and mean blood glucose. ResultsAn association was found between fructosamine and mean blood glucose, with an F statistic of 9.543 (p<0.001). Data were used to create a formula and conversion chart for calculating mean blood glucose from fructosamine levels for clinical use. ConclusionsThere is a complex relationship between average blood glucose, as determined by CGM and fructosamine. Fructosamine levels may be clinically useful for assessing short-term glycemic control when CGM is not available.

Case Series on Implementation of Continuous Glucose Monitoring for Better Glycemic Control without Long-acting Insulin

In our case series, we are describing 6 patients with uncontrolled, complicated type 2 Diabetes Mellitus (Type 2-DM). Although they were self-monitoring their blood glucose (SMBG) at least 4 times a day, they continued to have suboptimal glucose control. Continuous glucose monitoring (CGM) was started at our Internal medicine residency primary care clinic. The patients were educated on diet, lifestyle changes, and how to adjust their insulin regimen according to their blood glucose results from the CGM as the standard of care. They were called every two weeks by the representative of our CGM team to monitor and answer any queries regarding insulin adjustment, blood glucose monitoring, diet, physical activity, or lifestyle. The CGM team included Internal medicine and transitional year medical residents and a board-certified endocrinologist who was a member of our clinic. Moreover, the patients were seen at the clinic once every month by a member of the CGM team. Long and rapid-acting Insulins were started to achieve optimal glucose control initially. Eventually, Insulin dosage was gradually reduced, and the patients we described were started on alternate agents like oral antidiabetic agents with or without injectable glucagon-like peptide GLP-1 receptor agonists. The five-hour postprandial C-peptide was checked after discontinuation of insulin in all of our patients and was normal. Within a few months of CGM initiation, there was a significant improvement in the patients’ glucose control which was maintained after stopping the Insulin. Some patients were also able to lose weight. We concluded that CGM could be initiated safely in an internal medicine residency clinic not only at specialized endocrine clinics in a project that was managed primarily by internal medicine and transitional year residents under the supervision of a member of the clinic who was board certified in endocrinologists. We also demonstrated the introduction of CGM instead of SMBG in patients with Type 2-DM helped them to achieve better glycemic control with insulin, overcome glucose toxicity, and eventually stop the insulin and maintain excellent glucose control only with oral antidiabetic agents with or without injectable GLP 1 receptor agonist.

Continuous Glucose Monitoring and Reduced Diabetes-Related Hospitalizations in Patients with Type 2 Diabetes and CKD.

There is a heightened risk of glycemic variability in patients with diabetes and chronic kidney disease (CKD). This glycemic variability could lead to hypoglycemic or hyperglycemic crises. We hypothesized that initiation of continuous glucose monitoring (CGM), which provides a glucose measurement every 1-5 minutes, could reduce the incidence of hospitalizations for patients with type 2 diabetes (T2D) and CKD. A retrospective analysis of US administrative claims data from the Optum Clinformatics© Database was conducted. People with T2D, using insulin, not receiving dialysis, and living with stage 3-5 CKD who initiated CGM between 1/1/2016 and 3/31/2022 were identified. NDC and HCPCS codes were used to identify CGM device use and ICD-10 codes were used to identify CKD diagnosis and categorize healthcare encounters. Rates of diabetes-related hospitalizations were obtained, and multivariable logistic regression analyses revealed predictors of hypoglycemic and hyperglycemic encounters. A total of 8,959insulin-using patients with T2D and CKD were identified. Most were White (72.3%), had Medicare insurance coverage (82.2%), were using intensive insulin (91.3%), and had Stage 3 CKD (86.0%). After CGM initiation, rates of hospitalizations for hyperglycemia or hypoglycemia decreased by 18.2% and 17.0%, respectively (p<0.0001 for both). The proportion hospitalized with at least one hypoglycemic or hyperglycemic event also significantly decreased after CGM initiation. Significant predictors of both hypoglycemic and hyperglycemic encounters included a previous encounter of that type, age 30-59 years and depression (for hypoglycemia), and age 30-49 and neuropathy (for hyperglycemia). Use of CGM or glucagon-like peptide-1 receptor agonists was significantly protective against hypoglycemic encounters. Initiation of CGM was associated with significant reductions in diabetes-related hospitalizations among insulin-using individuals with T2D and moderate-to-severe CKD. CGM could help patients with T2D and CKD control their glucose and avoid potentially dangerous glycemic events.

Real-world glycaemic outcomes in patients with type 1 diabetes using glucose sensors-Experience from a single centre in Dublin.

To evaluate changes in glycated haemoglobin (HbA1 c) and sensor-based glycaemic metrics after glucose sensor commencement in adults with T1D. We performed a retrospective observational single-centre study on HbA1 c, and sensor-based glycaemic data following the initiation of continuous glucose monitoring (CGM) in adults with T1D (n = 209). We observed an overall improvement in HbA1 c from 66 (59-78) mmol/mol [8.2 (7.5-9.3)%] pre-sensor to 60 (53-71) mmol/mol [7.6 (7.0-8.6)%] on-sensor (p < .001). The pre-sensor HbA1 c improved from 66 (57-74) mmol/mol [8.2 (7.4-8.9)%] to 62 (54-71) mmol/mol [7.8 (7.1-8.7)%] within the first year of usage to 60 (53-69) mmol/mol [7.6 (7.0-8.4)%] in the following year (n = 121, p < .001). RT-CGM-user had a significant improvement in HbA1 c (Dexcom G6; p < .001, r = 0.33 and Guardian 3; p < .001, r = 0.59) while a non-significant reduction was seen in FGM-user (Libre 1; p = .279). Both MDI (p < .001, r = 0.33) and CSII group (p < .001, r = 0.41) also demonstrated significant HbA1 c improvement. Patients with pre-sensor HbA1 c of ≥64 mmol/mol [8.0%] (n = 125), had attenuation of pre-sensor HbA1 c from 75 (68-83) mmol/mol [9.0 (8.4-9.7)%] to 67 (59-75) mmol/mol [8.2 (7.6-9.0)%] (p < .001, r = 0.44). Altogether, 25.8% of patients achieved the recommended HbA1 c goal of ≤53 mmol/mol and 16.7% attained the recommended ≥70% time in range (3.9-10.0 mmol/L). Our study demonstrated that minimally invasive glucose sensor technology in adults with T1D is associated with improvement in glycaemic outcomes. However, despite significant improvements in HbA1 c, achieving the recommended goals for all glycaemic metrics remained challenging.

Continuous Glucose Monitoring Provides Durable Glycemic Benefit in Adolescents and Young Adults with Type 1 Diabetes: 12-Month Follow-Up Results

Objective. To further evaluate glycemic outcomes during the observational extension phase of the Continuous Glucose Monitoring (CGM) Intervention for Teens and Young Adults randomized clinical trial (RCT). Subjects and Methods. Following a 26-week RCT comparing CGM with blood glucose monitoring (BGM) in 153 adolescents and young adults aged 14 to &lt;25 years old with suboptimally controlled type 1 diabetes, 70 (89%) participants in the BGM group initiated use of CGM (referred to as BGM–CGM cohort), and 70 (95%) participants in the CGM group continued to use of CGM (CGM–CGM cohort) for an additional 26 weeks. Results. In the CGM–CGM cohort, mean hemoglobin A1c (HbA1c) decreased from 8.9% ± 0.9% (74 ± 9.8 mmol/mol) at randomization to 8.3% ± 1.3% (67 ± 14.2 mmol/mol) at 52 weeks ( p &lt; 0.001 ); however, significant improvement in time in target range (TIR) 70–180 mg/dL was not observed from prerandomization (38% ± 13%) to 52 weeks (41% ± 18%). Median percent time &lt;70 mg/dL decreased from 3.0% before randomization to 1.1% at 52 weeks ( p &lt; 0.001 ). In the BGM–CGM cohort, mean HbA1c decreased from 8.9% ± 1.2% (74 ± 13.1 mmol/mol) before CGM initiation to 8.5% ± 1.3% (69 ± 14.2 mmol/mol) after 26 weeks of CGM use ( p &lt; 0.001 ) and mean TIR increased from 34% ± 12% to 38% ± 15% ( p = 0.01 ). The median percent time &lt;70 mg/dL decreased from 3.3% before CGM initiation to 1.2% after 26 weeks of CGM use ( p &lt; 0.001 ). No participants discontinued CGM use during the extension phase. Conclusions. This further evaluation of CGM supports the findings of the preceding RCT that use of CGM improves glycemic control and reduces hypoglycemia in adolescents and young adults with type 1 diabetes. This trial is registered with NCT03263494.

Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial.

The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R2-decomposition was used to understand which variables contributed most to treatment satisfaction. A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.

1129-P: Continuous Glucose Monitoring (CGM) Initiation Shortly after Diagnosis Does Not Worsen Psychosocial States

Psychosocial impacts of early CGM initiation in youth soon after T1D diagnosis are underexplored. We report parent/guardian (PG) and youth trends in Patient Reported Outcomes (PROs) for families in the 4T Study 1. Of the 133 participants in the 4T Study 1, 125 PG and 60 youth (≥11 years) were eligible for PROs. PROs included Diabetes Distress Scale - Parent (mean DDS-P) for PG and for youth, Diabetes Distress Scale (DDS sum), PROMIS Pediatric Global Health (PGH sum), Diabetes Technology Attitudes (DTA sum), and CGM Benefits/Burden (BenCGM and BurCGM sum). Kruskal Wallis rank sum test evaluated temporal trends and sociodemographics were evaluated (Numerical: Wilcoxon rank; Categorical: Fisher's if n&amp;lt;5, Chi-squared if n≥5). PROs completion rates were higher for PG than youth at baseline (74% v 59%), 3 months (70% v 53%), and 6 months (66% v 50%). PG DDS-P remained low throughout the study (Table). Youth had favorable psychosocial trends (low DDS and high PGH), and perceived technology positively (high DTA and BenCGM with low BurCGM). Age, DKA at diagnosis, gender, ethnicity, insurance status, and language spoken were not associated with PROs scores in PG or youth. CGM initiation shortly after T1D diagnosis is not associated with poor or worsening PROs for PG and youth. These data suggest that early CGM initiation does not adversely impact psychosocial states for families and youth with T1D. Disclosure A.Addala: None. F.K.Bishop: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. P.Prahalad: None. M.Desai: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health. V.Ritter: None. B.Shaw: None. E.Pang: None. A.L.Cortes-navarro: None. I.Balistreri: None. A.Loyola: None. S.A.Alamarie: None. A.Schneider-utaka: None. Funding National Institutes of Health (K23DK13134201, R18DK122422)

1015-P: Impact of Social Vulnerability on Resources for CGM Initiation across Michigan Primary Care Practices

Objective: The Michigan Collaborative for Type 2 Diabetes (MCT2D) is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan. MCT2D aims to improve type 2 diabetes care by encouraging prescribing of continuous glucose monitoring (CGM), SGLT2i/GLP-1RA medications, and low carbohydrate diets. The study’s purpose was to describe clinic-level resources and barriers to CGM initiation in counties with high and low social vulnerabilities. Methods: We surveyed primary care practice providers about practice-level CGM patient education and barriers, and providers’ understanding of insurance coverage. 169 of 264 practices (64%) completed the survey. We classified practices as high vulnerability (HV; quartile 4), or low vulnerability (LV; quartiles 1-3) using the county-level CDC Social Vulnerability Index. Results: Among HV practices, the main CGM education was prescriber instruction (61.5%), while for LV it was printed material (69.8%). For both HV and LV practices the second most common educational resource was web links (53.9% and 51.6%, respectively). For both practice types, the most common barrier to CGM was patients’ lack of smartphone (60.5%, 62.4%, respectively), followed by patients’ lack of internet (55.3%) for HV practices and patients’ ability to use CGM (38.5%) for LV practices. Provider understanding of Michigan Medicaid CGM coverage policy was similar across practices with most reporting incorrectly that it was akin to Medicare (≥3 injections daily) (35.3% (HV) and 44.0% (LV)) or reporting lack of awareness of coverage (32.4% (HV) and 24.1% (LV)). Conclusions: There is a mismatch between practices’ educational approaches and patients’ access to technology. Improved transparency of CGM coverage criteria would enhance provider understanding and promote equitable access for patients. Limitations include that the data is county-level and further analysis evaluating other practice level social determinants of health is needed. Disclosure K.L.Khosrovaneh: None. R.Busui: Board Member; American Diabetes Association, Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp., Novo Nordisk, Roche Diagnostics, Procter &amp; Gamble, Research Support; Novo Nordisk, Medtronic, National Institutes of Health. C.D.Jamison: None. C.R.Richardson: Other Relationship; Annals of Family Medicine, JMIR Diabetes, Research Support; Dexcom, Inc., Blue Cross Blue Shield of Michigan, Neilson Foundation. H.L.Diez: None. J.E.Aikens: None. L.Oshman: Stock/Shareholder; Abbott, AbbVie Inc., Merck &amp; Co., Inc., Procter &amp; Gamble, Johnson &amp; Johnson, Eli Lilly and Company. J.Rau: None. J.Reiss: None. L.A.Young: None. J.Weisensel: None. P.Okeke: None. K.R.Mizokami-stout: None.

Asia-Pacific Perspectives on the Role of Continuous Glucose Monitoring in Optimizing Diabetes Management.

Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes.

Improvement of time in range and glucose management indicator in Type 1 and Type 2 Diabetes Mellitus patients after introduction of continuous Glucose monitoring in internal medicine residency clinic

Continuous glucose monitoring (CGM)-derived time in range (TIR) correlates with Glucose management indicator(GMI) which correlates with hemoglobin A1c (HbA1c) among patients with type 1 and type 2 diabetes mellitus. Compare to HbA1c it has better correlation with glucose control, because HbA1c can be influenced by conditions like anemia, Chronic kidney disease, Cirrhosis of the liver etc. With our current project we wanted to introduce CGM not in specialized endocrine clinic, but in Internal medicine Residency clinic. The CGM team had 12 Internal Medicine and Transitional year Residents who were functioning under the supervision of Board Certified Endocrinologist who was a member of the clinic also. Twenty Five patients -85% with type 2 DM and 15% with type 1 DM on multiple injections of Insulin per day-3-4, self-monitored their blood Glucose(SMBG). They were given CGM- Dexcom G6 in the clinic. In the first 2- weeks after the switch the TIR of the blood glucose of the patients-70-180 mg/dl was 18%. Their average blood glucose was 286 mg/dl, GMI was 11.21%. During then first 2- weeks after initiation of CGM the patients were educated in length by our CGM team about their diet, physical activity, how to adjust their Insulin based on their blood glucose levels as well as how to treat the hypoglycemia. Members of the CGM team were contacting the patients twice a week to adjust patients treatment with Insulin and other per oral antidiabetic medications and or injectable – GLP1-RAG if needed after consultation with the Endocrinologist in the clinic based on the shared information between the clinic and the patients. Once a month the patients were seen in the clinic by member of the CGM team as well. The patients were followed for 2- years. After 3- months on CGM and followed for the 2 years thereafter the patients TIR improved from 18 % to 74%, GMI decreased from 11.21% to 7.04% and the average blood glucose decreased from 286 mg/dl to 158 mg/dl. There was also significant reduction of the hypoglycemia. Twenty percent of the patients were able to discontinue their Insulin and be treated only with oral antidiabetic medications plus/minus GLP1-RAG and have GMI less than 7%. We have showed that targeted TIR – above 70% which has been associated recently with diabetic micro and macrovascular complications in diabetic patients can be achieved not only in specialized endocrine clinics , but in Internal Medicine residency clinic and can be adopted by other Internal Medicine Residency programs in USA.

Diabetes Technology and Therapy in the Pediatric Age Group.

Diabetes Technology and Therapy in the Pediatric Age Group.

'Much more convenient, just as effective': Experiences of starting continuous glucose monitoring remotely following Type 1 diabetes diagnosis.

Initiating continuous glucose monitoring (CGM) shortly after Type 1 diabetes diagnosis has glycaemic and quality of life benefits for youth with Type 1 diabetes and their families. The SARS-CoV-2 pandemic led to a rapid shift to virtual delivery of CGM initiation visits. We aimed to understand parents' experiences receiving virtual care to initiate CGM within 30 days of diagnosis. We held focus groups and interviews using a semi-structured interview guide with parents of youth who initiated CGM over telehealth within 30 days of diagnosis during the SARS-CoV-2 pandemic. Questions aimed to explore experiences of starting CGM virtually. Groups and interviews were audio-recorded, transcribed and analysed using thematic analysis. Participants were 16 English-speaking parents (age 43 ± 6 years; 63% female) of 15 youth (age 9 ± 4 years; 47% female; 47% non-Hispanic White, 20% Hispanic, 13% Asian, 7% Black, 13% other). They described multiple benefits of the virtual visit including convenient access to high-quality care; integrating Type 1 diabetes care into daily life; and being in the comfort of home. A minority experienced challenges with virtual care delivery; most preferred the virtual format. Participants expressed that clinics should offer a choice of virtual or in-person to families initiating CGM in the future. Most parents appreciated receiving CGM initiation education via telehealth and felt it should be an option offered to all families. Further efforts can continue to enhance CGM initiation teaching virtually to address identified barriers.

Dynamics of Hemoglobin A1c, Body Mass Index, and Rates of Severe Hypoglycemia in 4434 Adults with Type 1 or Type 2 Diabetes After Initiation of Continuous Glucose Monitoring.

Background: Continuous glucose monitoring (CGM) might have beneficial effects on glycemic control and body mass index (BMI) in adults with type 1 (T1D) or type 2 diabetes (T2D). Methods: The diabetes prospective follow-up registry was used to identify individuals with T1D or T2D ≥18 years starting CGM management in 2015 or later and follow-up information available. Hemoglobin A1c (HbA1c), BMI, and event rates of severe hypoglycemia in the year before CGM start were compared with two follow-up periods: (1) CGM use for 3-6 months and (2) CGM use for >6 months. Repeated measurements linear and negative binomial regressions were used (adjustment for sex, age at diabetes onset, and baseline parameters) and stratified by diabetes type. Results: Mean follow-up time was 1.8 years in T1D (n = 2994) and 1.9 years in T2D (n = 1440). In T1D, adjusted mean HbA1c decreased significantly from 7.65% (95% confidence interval: 7.62-7.68) at baseline to 7.54% (7.51-7.57) during follow-up. BMI increased slightly (baseline: 25.4 kg/m2 [25.3-25.5], follow-up >6 months: 25.8 kg/m2 [25.7-25.9]), whereas event rates of severe hypoglycemia were significantly lower after >6 months with CGM (9.0 events/100 patient-years [PY; 8.0-10.1]) compared with baseline (11.3 events/100 PY [10.4-12.2]) in adults with T1D. In T2D, HbA1c decreased from 7.21% (7.17%-7.25%) to 7.00% (6.95%-7.04%) and BMI did not change after CGM initiation. Conclusion: Our results provide real-world evidence on CGM management in adult individuals with T1D or T2D. We suggest strengthening patients' and physicians' readiness toward diabetes technology in T2D and more openness of health insurance to cover cost based on proven benefits.

1137-P: Continuous Glucose Monitoring (CGM) Use and Its Impact on Glycemic Control and Acute Complications among Older-Onset Type 1 Diabetes Patients within the Veterans Health Administration (VHA)

There is increasing recognition that older onset type 1 diabetes (T1D) is not uncommon. Although CGM use is rising dramatically among those with T1D, little is known regarding its use and benefits within this older T1D population. To address these questions, we identified new CGM users (new CGM sensor prescriptions for T1D developing after military enrollment) and non-users (T1D receiving care and glucose strips from the VHA) during the years 2015-2020 and used national VHA healthcare data and ICD-9/ICD-diagnostic codes from visit encounters to compare baseline characteristics, change in glucose control and new emergency (ER) or hospital admissions. Linear mixed models and Cox proportional models (with propensity score overlap weighting) , were used to compare pre/post changes in HbA1c, and time to acute admissions, respectively. Compared with 4732 nonCGM users, CGM users (n=5,143) had similar HbA1c levels but differed in many ways at initiation of CGM, including: being significantly younger (59 vs. 65 years) , higher proportion White (83 vs. 75%) , and more frequently using glucagon (36 vs. 12 %) , short-acting insulin (99 vs. 86%) and insulin pumps (54 vs.7%) . After propensity overlap weighting, all characteristics were nearly identical between groups. Initiation of CGM was associated with reduced HbA1c levels (- 0.2 and -0.26% at 6 and 12 months (p’s&amp;lt; 0.001) compared with nonCGM users. Similarly, CGM users also had greater declines in risk for total hospitalizations (HR = .88; CI 0.79-0.98) and hypoglycemic (HR = .69; CI 0.53-0.90) and hyperglycemic (HR = .77; CI 0.64-0.94) related ER visits/hospitalizations (all p’s &amp;lt; 0.02) . In this large national study of CGM initiation in older T1D patients, CGM use was linked with improved glucose control as well as reduced ER and/or hospital admissions for hypoglycemia, hyperglycemia or any cause. Disclosure J.Zhou: Research Support; Dexcom, Inc. M.Newell: Research Support; Dexcom, Inc. S.Rivas: None. X.Zhou: None. G.J.Norman: Employee; Dexcom, Inc. P.Reaven: Research Support; AstraZeneca, Dexcom, Inc. Funding DexCom, Inc

82-LB: Improvement of Glycemic Control in People with Type 2 Diabetes Using Basal Insulin (PwT2D-BI) and Continuous Glucose Monitoring (CGM) —U.S. Study Using Machine Learning (ML)

Background: CGM provide real-time glucose data that allows users to manage their diabetes holistically. This study aimed to assess the association between glycemic control and CGM use in PwT2D-BI. Methods: This retrospective study used IBM MarketScan® 2015 - 2019 Databases to identify PwT2D-BI with (CGM) and without (control) use of CGM. CGM users were followed from first BI until CGM initiation, defined as index date (ID) . The ID of non-CGM controls were randomly assigned based on time between first BI and ID of CGM. . Comparison CGM use for 6 and 12 months were performed using Frequentist Model Averaging (FMA) in a ML framework adjusting for baseline characteristics. Model strategies were applied including matching, weighting, stratification and regression. Results: A total of 5,934 PwT2D-BI (251 CGM; 5,683 control) were included in the study (Table 1) . Observed A1c reduction from baseline to 12 months was 0.87%, 0.95% for 6 and 12 months of CGM use, respectively vs. 0.32% for controls. FMA analyses found CGM users had a statistically significantly greater reduction in A1c both at 6 months (treatment difference 0.30 [0.13,0.48]) and 12 months (0.50 [0.37, 0.72]) . Conclusion: Findings suggest that CGM use for at least 6 months in PwT2D-BI has clinical benefit as demonstrated by A1c reduction in the real-world setting. Disclosure C. Chinthammit: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A. J. M. Brnabic: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. M. Perez-nieves: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

1138-P: Impact of Continuous Glucose Monitoring (CGM) on Glycemic Control and Acute Complications in Type 2 Diabetes (T2D) in the Veterans Health Administration (VHA)

Use of CGM in T2D is rising rapidly, yet little is known regarding its effects on glucose management in the VHA. We thus identified new CGM users (new CGM sensor prescriptions for T2D on insulin) and non-users (T2D receiving glucose strips) during the years 2015-2020 and used national VHA healthcare data from visit encounters to compare change over 12 months in glucose control and new emergency room (ER) or hospital admissions. Changes in HbA1c and acute admissions were compared by linear mixed models and generalized linear models, respectively. Compared with 36,082 non-users, CGM users (n=16,013) differed in many ways but were well-balanced with overlap weighting from propensity score modeling. CGM users had a greater reduction in HbA1c over 12 months (-0.25%; 95% CI -0.21-0.29, p&amp;lt;0.0001) and a decline in hypoglycemia related ER visits/hospitalizations (OR = 0.78; CI 0.62-0.97) . Among CGM users, those &amp;lt; 65 years old or with initial HbA1c &amp;gt; 8. 4% (median) had greater reductions in HbA1c, while those at higher hypoglycemia risk had reduced hypoglycemia and hyperglycemia related ER visits/hospitalizations and all-cause hospitalizations (Table) . In this large national study in T2D, CGM initiation was linked with better glucose control and reduced ER and/or hospital admissions for hypoglycemia and showed even greater benefits in subsets of CGM users. Disclosure P.Reaven: Research Support; AstraZeneca, Dexcom, Inc. M.Newell: Research Support; Dexcom, Inc. S.Rivas: None. X.Zhou: None. G.J.Norman: Employee; Dexcom, Inc. J.Zhou: Research Support; Dexcom, Inc. Funding DexCom, Inc

Continuous Glucose Monitor Use Prevents Glycemic Deterioration in Insulin-Treated Patients with Type 2 Diabetes.

Continuous glucose monitoring (CGM) is indicated in poorly controlled insulin-treated patients with type 2 diabetes (T2D) to improve glycemic control and reduce the risk of hypoglycemia, but the benefits of CGM for lower risk patients have not been well studied. Among 17,422 insulin-treated patients with T2D with hemoglobin A1c (HbA1c) <8% and no recent severe hypoglycemia (based on emergency room visits or hospitalizations), CGM initiation occurred in 149 patients (17,273 noninitiators served as reference). Changes in HbA1c and severe hypoglycemia rates for the 12 months before and after CGM initiation were calculated. CGM initiation was associated with decreased HbA1c (-0.06%), whereas noninitiation was associated with increased HbA1c (+0.32%); a weighted adjusted difference-in-difference model of change in HbA1c yielded a net benefit of -0.30%; 95% CI -0.50%, -0.10%; P = 0.004). No significant differences were observed for severe hypoglycemia. CGM may be useful in preventing glycemic deterioration in well-controlled patients with insulin-treated T2D.

Delays in Continuous Glucose Monitoring Device Initiation: A Single Center Experience and a Call to Change.

Background: Continuous glucose monitoring (CGM) has been increasingly shown to be beneficial in patients with both types 1 and 2 diabetes using insulin. Despite this, challenges remain in obtaining coverage for these devices. We sought to define the process of initiation of CGM and better understand factors associated with successful initiation. Methods: A single-center retrospective cohort study of 271 patients seen over a 3-year period from 2017 to 2020 in the adult endocrinology clinic at Boston Medical Center who were prescribed CGM was performed. The primary outcome was time to CGM initiation. Secondary outcomes included factors associated with initiation and continued use of CGMs and glycemic control. Results: Obtaining CGM through pharmacy benefit was significantly faster than through durable medical equipment companies (78 days vs. 152 days, P < 0.0001). Factors associated with initiation of CGM were younger age, private insurance, and education with a clinical diabetes educator. Identifying as black or Hispanic was significantly associated with decreased initiation of CGM. Glycemic control as represented by hemoglobin A1c improved in patients initiated on CGM from 9.06% to 8.22% (P < 0.001). Conclusion: Prescribing CGM as a pharmacy benefit significantly reduces the time to initiation, but on average, still takes several months, delaying potentially life-saving care for patients living with diabetes. Barriers to CGM initiation must be addressed to ensure timely delivery of optimal care to our patients.