Utility Of Continuous Glucose Monitoring Research Articles

Real-World Continuous Glucose Monitoring Data from a Population with Type 1 Diabetes in South Korea: Nationwide Single-System Analysis.

Background: We used continuous glucose monitoring (CGM) data to investigate glycemic outcomes in a real-world population with type 1 diabetes (T1D) from South Korea, where the widespread use of CGM and the nationwide education program began almost simultaneously. Methods: Data from Dexcom G6 users with T1D in South Korea were collected between January 2019 and January 2023. Users were included if they provided at least 90 days of glucose data and used CGM at least 70% of the days in the investigational period. The relationship between CGM utilization and glycemic metrics, including the percentage of time in range (TIR), time below range (TBR), and time above range (TAR), was assessed. The study was approved by the Institutional Review Board of Samsung Medical Center (SMC 2023-05-030). Results: A total of 2288 users were included. Mean age was 41.5 years (57% female), with average uploads of 428 days. Mean TIR was 62.4% ± 18.5%, mean TBR <70 mg/dL was 2.6% ± 2.8%, mean TAR >180 mg/dL was 35.0% ± 19.3%, mean glucose was 168.1 ± 35.8 mg/dL, mean glucose management indicator was 7.2% ± 0.9%, and mean coefficient of variation was 36.7% ± 6.0%. Users with higher CGM utilization had higher TIR (67.8% vs. 52.7%), and lower TBR <70 mg/dL (2.3% vs. 4.7%) and TAR >180 mg/dL (30.0% vs. 42.6%) than those with low CGM utilization (P < 0.001 for all). Users whose data were shared with others had higher TIR than those who did not (63.3% vs. 60.8%, P = 0.001). Conclusions: In this South Korean population, higher CGM utilization was associated with a favorably higher mean TIR, which was close to the internationally recommended target. Using its remote data-sharing feature showed beneficial impact on TIR.

Continuous Glucose Monitoring Metrics for Pregnancies Complicated by Diabetes: Critical Appraisal of Current Evidence.

Ascertaining the utility of continuous glucose monitoring (CGM) in pregnancy complicated by diabetes is a rapidly evolving area, as the prevalence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes mellitus (GDM) escalates. The seminal randomized controlled trial (RCT) evaluating CGM use added to standard care in pregnancy in T1D demonstrated significant improvements in maternal glycemia and neonatal health outcomes. Current clinical guidance recommends targets for percentage time in range (TIR), time above range (TAR), and time below range (TBR) during pregnancy complicated by T1D that are widely used in clinical practice. However, the superiority of CGM over blood glucose monitoring (BGM) is still questioned in both T2D and GDM, and whether glucose targets should be different than in T1D is unknown. Questions requiring additional research include which CGM metrics are superior in predicting clinical outcomes, how should pregnancy-specific CGM targets be defined, whether CGM targets should differ according to gestational age, and if CGM metrics during pregnancy should be similar across all types of diabetes. Limiting the potential for CGM to improve pregnancy outcomes may be our inability to maintain TIR > 70% throughout gestation, a goal achieved in the minority of patients studied. Adverse pregnancy outcomes remain high in women with T1D and T2D in pregnancy despite CGM technology, and this review explores the potential reasons and questions yet to be investigated.

Patterns and Trends in Continuous Glucose Monitoring Utilization Among Commercially Insured Individuals With Type 1 Diabetes: 2010–2013 to 2016–2019

Prior studies suggest that only ∼30% of patients with type 1 diabetes use continuous glucose monitoring (CGM), but most studies to date focused on children and young adults seen by endocrinologists or in academic centers. This study examined national trends in CGM utilization among commercially insured children and adults with type 1 diabetes. Overall, CGM utilization was 20.12% in 2010–2013 and 49.78% in 2016–2019, reflecting a 2.5-fold increase in utilization within a period of &amp;lt;10 years. Identifying populations with low CGM use is a necessary first step in developing targeted interventions to increase CGM uptake.

A systematic bibliometric analysis on the clinical practice of CGM in diabetes mellitus from 2012 to 2022.

Continuous glucose monitoring (CGM) has revolutionized diabetes management, but a comprehensive analysis of its clinical implementation is lacking. This study aims to explore CGM in diabetes practice over the past decade using bibliometric analysis. It will identify trends, research focal points, and provide a framework for future investigations. The Web of Science Core Collection (WOSCC) was utilized to acquire literature pertaining to the employment of continuous glucose monitoring (CGM) in diabetes that was published between the years 2012 and 2022, and to conduct a comprehensive analysis of the associated citation data. To achieve bibliometric visualization and analysis of the collated data, the bibliography package in the Rstudio(v.4.2.2), Citespace 6.2.R4, and VOS viewer were employed. A total of 3024 eligible publications were extracted from 91 countries, with the United States being the leading country in terms of the number of issued articles. Furthermore, the annual publication rate has shown a gradual increase during the past decade. Among the various journals in this field, DIABETES TECHNOLOGY & THERAPEUTICS was identified as the most highly cited one. Keyword clustering analysis of the extracted publications indicates that the research hotspots in the past decade have primarily focused on "continuous glucose monitoring", "glycemic variability", "type 1 diabetes", "hypoglycemia", and "glycemic control". Moreover, the analysis of keyword emergence reveals that "Time In Range" and "Young Adult" represent the current research frontiers for the years 2012-2022. The concept of Time in Range (TIR) has garnered considerable attention as a significant area of inquiry and an emerging research trend in the clinical practice of Continuous Glucose Monitoring (CGM) for Diabetes Mellitus. Moreover, recent investigations have demonstrated a growing focus on young adults with type 1 diabetes as the research population of interest. In the foreseeable future, research endeavors will persist in the pursuit of improving glycemic management among young adults through the utilization of continuous glucose monitoring (CGM) technology, while also delving into the examination of the Time in Range metric via supplementary clinical investigations.

359-OR: Variation in Utilization of Continuous Glucose Monitoring in Patients with Type 1 Diabetes

Background: Continuous glucose monitoring (CGM) is recommended by the American Diabetes Association for patients with type 1 diabetes (T1D) but remains underutilized. Prior studies suggest ~30% of patients with T1D use CGM with variation by race/ethnicity reported. Methods: We used electronic health record data from an academic medical center (1/1/2018-12/31/2021) to examine variation in CGM utilization in patients with T1D and describe demographic factors associated with CGM use via multivariate logistic regression adjusted for clinical variables outlined in Table 1. Results: Among 3,382 patients with T1D (aged 28.6 ± 17.8 y; 51% female; 83% non-Hispanic White), 52% used CGM during study period. CGM utilization was significantly lower in older (age 65+) versus younger patients (age 0-13; OR=0.15, 95% CI: 0.09, 0.26), Hispanic versus non-Hispanic White patients (OR=0.44, 95% CI: 0.21, 0.94) and patients with commercial versus government-issued insurance coverage (Medicaid, OR=0.44, 95% CI: 0.37, 0.52; Medicare, OR=0.42, 95% CI: 0.30, 0.50). Conclusions: In this population of patients with T1D, 1 in 2 patients used CGM to manage their diabetes but there was significant variation. Identifying populations with lower-than-expected utilization is a necessary first step in developing targeted interventions to increase CGM uptake and, ultimately, improve short and long-term T1D-related outcomes. Disclosure M.E.Lacy: None. J.Fowlkes: None. K.Heier: None. M.Sohn: None. A.J.Kruse-diehr: None. T.Waters: None. D.C.Moga: None. Funding National Institutes of Health (UL1TR001998, KL2TR001996)

935-P: Racial and Ethnic Disparities in the Application of Continuous Glucose Monitoring in Real-World Clinical Settings

Background: The use of continuous glucose monitoring (CGM) has improved glycemic control. Disparity in CGM use has been reported; however, the utilization of CGM across a health system in real-world clinical settings remains unknown. We aimed to characterize patients who use CGM and compare them to patients with diabetes who do not use CGM in a large health system. Methods: We retrospectively reviewed the electronic health record (EHR) of patients who received care at NYU Langone Health from 2015. CGM users were those whose EHR records had at least one uploaded CGM report, while CGM non-users were those who had at least one outpatient encounter in which a diabetes diagnosis was documented and who did not have any CGM files uploaded into Epic. Results: We identified 10,515 CGM users and 108,395 CGM non-users. CGM use significantly increased in patients with type 2 diabetes (T2D) after 2019, with higher use of CGM in patients with T2D than those with type 1 diabetes (T1D) (63.6% vs. 36.4%; p&amp;lt;.001). The rate of CGM use was significantly different across racial/ethnic groups: 9.9% of Whites, 7.8% Hispanics/Latinos, 7.5% African Americans, 7.2% Asian, and 7.1% Native Americans. When comparing CGM user among racial groups, CGM user was higher (than non-use) among Whites (60.4% vs 53.1%) and Filipinos (0.68% vs 0.55%), but less frequent among African Americans (13.0% vs 15.6%), Chinese (0.71% vs 1.7%), and Koreans (0.19% vs 0.45%) (p&amp;lt;.001). Regarding the ethnicity, more CGM users were Salvadoran (0.83% vs 0.45%), while less were Puerto Rican (3.3% vs 3.6%), Dominican (1.2% vs 1.4%), and Mexican (0.55 vs 1.4) (p&amp;lt;.001). Conclusions: Using a large real-world clinical setting dataset, our study identified disparity in the CGM use in patients with T1D compared to T2D. Further we noted racial/ethnic disparities in the CGM use and heterogeneity within Hispanics and Asian Americans. Researchers and clinicians should consider interventions to reduce disparities in CGM prescription patterns. Disclosure Y.Zheng: None. E.Iturrate: None. B.Wu: None. J.Fletcher: None. G.D.Melkus: None. S.B.Johnson: None. Funding National Institutes of Health (P30DK111022)

1146-P: Changes in Parent/Guardian and Youth Patient Reported Outcomes (PROs) after T1D Diagnosis for Families in the 4T Study 1

The 4T Study 1 is a clinical pragmatic research trial that starts continuous glucose monitoring (CGM) within 30 days of T1D diagnosis and monitors PROs. We report the longitudinal relationship of PROs between newly diagnosed youth and parents/guardians (PG). PROs surveys were administered to youth and PG at baseline, 3, and 6 months. PG PROs included the 20-item parent Diabetes Distress Scale (DDS-P) and youth PROs were the 2-item Diabetes Distress Scale (DDS-2) and the 7-item PROMIS Pediatric Global Health Scale (PGH-7). Pearson correlations evaluated the relationship between scores on the PG and youth PROs. Youth (n=60 who were aged ≥11 years) with new onset T1D and their PG (n=125) were eligible to complete PROs, yet response rates varied (at baseline, 3-, 6-months: Youth 59%, 53%, and 50% vs PG 74%, 70%, and 66%). Correlations showed that PG diabetes distress was positively correlated with child diabetes distress at baseline (r=0.48, p=0.003) and at 3 months (r= 0.35, p=0.058). However, by 6 months, this association decreased in strength and significance (r=0.16, p=0.42). Youth global health was inversely correlated with PG diabetes distress at baseline (r=-0.36, p=0.029) and 3 months (r=-0.53, p=0.002) and this correlation was not significant at 6 months (r =-0.049, p=0.81). These data suggest that the relationship between PG diabetes distress and youth psychosocial states are dynamic. PG and youth psychosocial states are strongly associated after diagnosis and decrease over time. Utilization of CGM, age, T1D duration, response rate, and changes in the PG-youth relationship (such as decreased adult involvement or increased independence of youth) may contribute to our findings. Further investigation of longitudinal relationships between PG and youth PROs may provide additional insight into PG and youth psychosocial states and diabetes outcomes and indicate optimal timing for assessment and treatment referral. Disclosure S.A.Alamarie: 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. A.Addala: None. E.Pang: None. A.L.Cortes-navarro: None. N.Arrizon-ruiz: None. I.Balistreri: None. A.Loyola: None. A.Schneider-utaka: None. V.Ritter: None. B.Shaw: None. Funding National Institutes of Health (R18DK122422)

969-P: Utilization of Continuous Glucose Monitoring (CGM) among Older Adults with Type 1 Diabetes (T1D)—An Analysis of Real-World Clinical Data

There is a dearth of data to quantify the utilization of diabetes technology among the growing population of older adults with T1D. We assessed differences in the use of CGM between those receiving endocrine care versus those not. We analyzed electronic health record (EHR) data from a large, public health care system in the southeast US, including 12 affiliated hospitals and over 200 academic and community-based practices. We included data from adults ages 65+ years with T1D in 04/01/2019-2022. We used logistic regression to model the likelihood of using CGM among those who had a visit with endocrinology in the past year versus those who did not. We used entropy balancing weights to create an analytic sample that was balanced on covariates. Our sample included 560 older adults with T1D, comprised of 32% using CGM. Of CGM users, 43% had an endocrinology appointment and 22% did not. Those with endocrine care had higher odds of using CGM compared to those who did not (aOR: 2.38, 95% CI: 1.65, 3.45). In probability terms, those with an endocrinology appointment in the previous year had a 17.8 percentage point (95% CI: 9.9, 25.6) higher probability of using CGM than those who did not (Fig). In a regional sample, we found relatively low CGM utilization and disparities therein across the receipt of endocrine care among older adults with T1D. Limitations include data from one healthcare system only. Disclosure A.R.Kahkoska: None. J.M.Weinstein: Research Support; Dexcom, Inc. R.Muthukkumar: None. L.A.Young: Research Support; Novo Nordisk, Rhythm Pharmaceuticals, Inc., Eli Lilly and Company, Jaeb Center for Health Research, Sanofi, Boehringer-Ingelheim. Funding National Institutes of Health (KL2TR002490, UL1TR002489)

What Role Might There Be for Continuous Glucose Monitoring in the Assessment of Diabetes Risk?

The term "prediabetes" has traditionally been used to describe the state of abnormal glucose homeostasis (dysglycemia) that could eventually lead to developing clinical type 2 diabetes. The HbA1c, oral glucose tolerance testing, and fasting glucose measurements represent the standard approaches for assessing risk. However, they do not predict with complete accuracy, nor do they provide individualized risk assessment to determine who will develop diabetes. Use of continuous glucose monitoring (CGM) provides a more complete picture of inter- and intraday glucose excursions that may help clinicians and patients quickly identify dysglycemia and make informed personalized intervention decisions. This article discusses the utility of CGM as a tool for both risk assessment and risk management.

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.

Use of Continuous Glucose Monitors to Manage Type 1 Diabetes Mellitus: Progress, Challenges, and Recommendations.

Type 1 diabetes (T1D) management has been revolutionized with the development and routine utilization of continuous glucose monitoring (CGM). CGM technology has allowed for the ability to track dynamic glycemic fluctuations and trends over time allowing for optimization of medical therapy and the prevention of dangerous hypoglycemic events. This review details currently-available real-time and intermittently-scanned CGM devices, clinical benefits, and challenges of CGM use, and current guidelines supporting its use in the clinical care of patients with T1D. We additionally describe future issues that will need to be addressed as CGM technology continues to evolve.

Paediatric Society and Hyperinsulinism Charity National Surveys on CGM Access for Patients With Recurrent Hypoglycaemia.

Recurrent hypoglycemia can result in significant neurological impairments in children and continuous glucose monitoring (CGM) technology has been shown to reduce recurrent hypoglycemia in conditions such as type 1 diabetes. In the United Kingdom, CGM devices are currently only recommended by the National Institute of Clinical Excellence (NICE) for patients with diabetes and not for other diagnoses. To examine access to CGM technology for children and young people with recurrent hypoglycemia in the United Kingdom. In 2021, the British Society of Paediatric Endocrinology and Diabetes (BSPED) conducted a national health professional survey in England, Wales, Scotland, and Northern Ireland looking at CGM access to funding for children and young people with recurrent hypoglycemia, without the diagnosis of diabetes. The UK Children's Hyperinsulinism Charity (UK CHC) also conducted a national patient survey. Responses from BSPED were received from 55 units while the UK CHC received 69 responses from individual families, the largest response to a survey carried out by the charity. The results of the BSPED and UK CHC surveys found that funding streams for CGM were highly variable. Only 29% were able to access CGM for recurrent hypoglycemia and from these, 65% were self-funding CGM. Quality of life benefits were evident from the UK CHC survey on the utility of CGM in reducing worry, improving sleep, lessening the burden of frequently finger-pricking and reducing out-of-hours appointments as a result of hypoglycemia. Patient-reported utilization rates of blood glucose test strips per week were significantly reduced. BSPED and UK CHC national surveys support a call and a consideration for CGM access to be widened to patients who suffer from recurrent hypoglycemia such as those with hyperinsulinism or metabolic conditions. The prevention of recurrent hypoglycemia and improving quality of life for patients and carers remain a cornerstone management for people who suffer from frequent hypoglycemia. CGM education is critical to support its use and understand its limitations. Further research is warranted to determine the safety and efficacy of CGM in detection and reduction of hypoglycemic events, impact of hospital stay, and long-term neurological outcomes in those who suffer from recurrent hypoglceamia.

Impact of Expanding Access to Continuous Glucose Monitoring Systems Among Insulin Users with Type 1 or Type 2 Diabetes.

Background: Despite increased use of continuous glucose monitoring (CGM) systems, studies to quantify patterns of CGM use are limited. In December 2018, a policy change by a commercial insurer expanded coverage of CGM through the pharmacy benefit, creating an opportunity to evaluate the impact of this change on CGM utilization. Research Design and Methods: Pharmacy and medical claims from 2016 to 2020 were used to estimate the prevalence of CGM use among insulin users with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) before and after the policy change. Change in CGM use was assessed using an interrupted time series design. Results: At the beginning of the study period, 18.8% of T1DM patients and 1.2% of T2DM patients used CGM. Use rose to 30.5% and 6.6% in the quarter before the policy change. The policy resulted in an immediate 9.5% (P < 0.0001) and 2.8% (P < 0.0001) change in use and increased the rate of quarterly change by 0.5% (P = 0.002) and 0.8% (P < 0.0001). At the end of the study period, 58.2% and 14.9% of T1DM and T2DM patients used CGM. Conclusion: CGM use significantly increased after addition to the pharmacy benefit. Rate of change in CGM use was lower in T1DM compared to the T2DM population, but overall use remained higher among patients with T1DM. Increased CGM use in the population studied aligns with those whose clinical guidelines suggest would most likely benefit. Additional work is needed to evaluate the impact of this benefit change on health care spending and outcomes.

Serum Glucose Variability Increases the Risk of Complications Following Aseptic Revision Hip and Knee Arthroplasty.

Increased serum glucose variability has been proposed as a risk factor for perioperative morbidity and mortality. Given the greater surgical complexity and complication risk of revision total joint arthroplasty (TJA), previous findings may not be generalizable to the revision population. The purpose of this study was to investigate the association between glucose variability and postoperative complications following aseptic revision TJA. We identified 1,983 patients who underwent an aseptic revision TJA (636 total knee arthroplasties [TKAs] and 1,347 total hip arthroplasties [THAs]) from 2001 to 2019. Patients with ≥2 postoperative glucose values per day or ≥3 values during hospitalization were included in this study. Glucose variability was assessed using the coefficient of variation (COV). Outcomes included length of hospital stay, 90-day complications, mortality, and periprosthetic joint infection (PJI) as defined by the 2018 International Consensus Meeting criteria. Multivariate regression was used to determine the association between glucose variability and each end point, using COV as continuous and categorical variables (that is, COV tertiles). Patients with high glycemic variability were at 1.7 times greater risk for 90-day complications (odds ratio [OR], 1.664 [95% confidence interval (CI), 1.266 to 2.188]; p < 0.001) and 2 times greater risk for PJI at a minimum 1-year follow-up (OR, 1.984 [95% CI, 1.270 to 3.100]; p = 0.003). The risk of 90-day complications increased by 2.2% (OR, 1.022 [95% CI, 1.012 to 1.032]; p < 0.001) and the risk of PJI increased by 1.8% (OR, 1.018 [95% CI, 1.003 to 1.034]; p = 0.013) for every percentage-point increase in COV. Patients with higher glucose variability also had a longer length of stay (beta, 1.028 days [95% CI, 0.590 to 1.466 days]; p < 0.001). These associations were independent of age, sex, body mass index, Charlson Comorbidity Index, involved joint, operative time, history of diabetes, and mean glucose levels. Higher glucose variability was associated with an increased risk of medical complications and PJI following aseptic revision TJA. Patients undergoing these complex procedures should have glucose levels monitored closely in the perioperative period. Future studies should evaluate the utility of continuous glucose monitoring in this high-risk population. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

168-OR: Patterns of Continuous Glucose Monitoring Utilization in Adults with Type 1 Diabetes, 2016–2019

Background: Continuous glucose monitoring (CGM) improves diabetes control by reducing HbA1c and decreasing rates of hypoglycemia. Despite clinical benefits and clear guidelines from the American Diabetes Association, &amp;lt;20% of patients with T1DM use CGM. Studies report disparities in CGM among youth with T1D by race/ethnicity, socioeconomic status, and region, but, insight into patterns of CGM utilization in adults with T1D is limited. Methods: We evaluate CGM utilization among individuals with T1D age ≥18 using Truven MarketScan and Medicare Supplementary databases from 1/1/2016-12/31/2019. CGM utilization was determined using CPT, NDC and HCPCS codes. Individuals with &amp;gt;365 days of continuous eligibility were followed from their first diabetes-related diagnosis code until: end of the study period, &amp;gt;120 day gap in coverage, or CGM claim. CGM utilization was analyzed by patient demographics (age, sex, region, employment status) , and clinical characteristics (insulin pump, diabetes complications) . Results: A total of 228,846 enrollees with T1D were included. Average (SD) age at baseline was 52.2 (16.8) ; 47% of the sample was female, 26% were on an insulin pump and the regional distribution of was: 26% North Central, 21% Northeast, 41% South, 11% West. Overall, 36.5% (n=60,034) of beneficiaries had a claim for CGM. Rates of CGM utilization ranged from 59% in those aged 18-25 to 16% in those 65+ (p&amp;lt;0.0001) , 38% in women vs. 35% in men (p&amp;lt;0.0001) , and 34% in North Central and Northeastern US vs. 40.2% in West (p&amp;lt;0.0001) . Conclusions: We found differential utilization of CGM by sex, age group and geographic region. Those aged 18-25 were 3 times more likely to utilize CGM compared to those 65+, a subgroup at high risk for severe hypoglycemic events and hypoglycemia unawareness. CGM is a highly effective tool for improving glucose control and preventing acute hypoglycemia, yet only 1/3 of the population sampled had evidence of use underscoring the need to understand barriers to utilization. Disclosure K.E.Lee: None. J.Fowlkes: None. M.E.Lacy: None. Funding National Institutes of Health (UL1TR000117, UL1TR001998, KL2TR001996)

67-LB: Nursing Perspectives on Hospital Use of Dexcom Continuous Glucose Monitor in Patients with Suspected or Known COVID-19 during Insulin Infusion

The coronavirus disease 2019 pandemic resulted in the need for remote glucose monitoring in intensive care unit (ICU) patients requiring insulin infusions. While rarely reported, perceptions from nursing staff are critical for successful implementation and expanded use. A hybrid continuous glucose monitoring (CGM) and intermittent point of care (POC) glucose monitoring was developed at the study institution. After 1.5 years of protocol use, an anonymous survey was distributed electronically to ICU nurses to obtain their perspectives on CGM utilization. The survey employed a 1-5 Likert scale regarding CGM sensor insertion, accuracy, acceptability, and usability as well as perceptions on reduced room entry and reduced workload. Of the 51 surveys completed, 50 (98%) nurses reported they cared for an ICU patient enrolled in the CGM protocol and 31 (62%) started or replaced a CGM sensor. A representative sample of questions and responses is shown in table 1. ICU nurses overwhelmingly reported CGM was accurate, reduced their workload, provided safer patient care, and was preferred over POC glucose testing alone. These results confirm nursing acceptance and preference for CGM use within a hybrid glucose monitoring protocol in the ICU setting. Disclosure J. Pattison: None. K. M. Dungan: Advisory Panel; Dexcom, Inc., Consultant; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Elsevier, Nova Biomedical, Novo Nordisk, Tolerion, Inc., Other Relationship; UpToDate, Research Support; Abbott, Dexcom, Inc., Novo Nordisk, Sanofi, ViaCyte, Inc., Speaker’s Bureau; Academy for Continued Healthcare Learning, Cardiometabolic Health Congress, Medscape. E. Buschur: Advisory Panel; Beta Bionics, Inc., Research Support; Dexcom, Inc. M. C. Exline: Other Relationship; Abbott. L. G. Jones: None. C. May: None. M. Mcnett: None. K. Smetana: None. E. R. Faulds: Advisory Panel; Dexcom, Inc., Research Support; Dexcom, Inc., Speaker’s Bureau; Medscape.

912-P: Integrating CGM Use into Primary Care Practice: A Diabetes Quality Improvement Project

Background: Continuous glucose monitoring (CGM) is a powerful tool to help manage diabetes. Primary care providers (PCPs) have been slow to incorporate CGM into practice, representing a significant gap in healthcare delivery. We implemented a quality improvement intervention at our primary care clinic to increase utilization of CGM. Methods: We conducted a pre-intervention survey with PCPs to assess baseline knowledge and comfort with CGM, followed by a 6 month post-intervention survey. Our interventions included the creation of a CGM toolkit, provider education, and implementation of an office workflow for prescribing CGM and educating patients. Our primary outcome measure was the number of CGM prescriptions written. Secondary outcome measures included change in provider knowledge and comfort with CGM use, and change in hemoglobin A1c after 3-6 months of CGM use. Results: Our survey asked providers to rate their comfort and familiarity with CGM along with questions regarding barriers to CGM use. The baseline survey showed that provider familiarity and comfort explaining CGM to patients was poor, frequently rated as a 1 or 2 (1= not at all familiar, 5= very familiar) . Six months after implementation of our toolkit and education, 70% of providers responded with a 4 or 5. We identified 41 clinic patients who had CGM prescriptions in the six month time period prior to our study initiation. Six months after intervention, a total of 1patients had CGM prescriptions (146% increase) . Of the 60 patients newly prescribed CGM, we obtained retrospective data on patients. Mean hemoglobin A1c of was 9.96% at baseline and improved to 8.29% after 3-6 months of CGM use (change of 1.67%) . Conclusion: Implementation of a toolkit focusing on provider education and an organized workflow for prescribing can increase the use of CGM in primary care practice, as well as positively affect provider knowledge and comfort with CGM use. Our preliminary data indicates that patients may also benefit from improved glycemic control. Disclosure R.Mamtani: None. T.Wolinsky: Other Relationship; Pfizer Inc. B.Simon: None. Funding American Diabetes Association

Utility of Continuous Glucose Monitoring vs Meal Study in Detecting Hypoglycemia After Gastric Bypass.

Gastric bypass (GB) increases postprandial glucose excursion, which in turn can predispose to the late complication of hypoglycemia. Diagnosis remains challenging and requires documentation of symptoms associated with low glucose and relief of symptom when glucose is normalized (Whipple triad). To compare the yield of mixed meal test (MMT) and continuous glucose monitoring system (CGMS) in detecting hypoglycemia after GB. The study was conducted at General Clinical Research Unit, Cincinnati Children's Hospital (Cincinnati, OH, USA). Glucose profiles were evaluated in 15 patients with documented recurrent clinical hypoglycemia after GB, 8 matched asymptomatic GB subjects, and 9 healthy weight-matched nonoperated controls using MMT in a control setting and CGMS under free-living conditions. Patients with prior GB had larger glucose variability during both MMT and CGMS when compared with nonsurgical controls regardless of their hypoglycemic status. Sensitivity (71 vs 47%) and specificity (100 vs 88%) of MMT in detecting hypoglycemia was superior to CGMS. Our findings indicate that a fixed carbohydrate ingestion during MMT is a more reliable test to diagnose GB-related hypoglycemia compared with CGMS during free-living state.

Health Care Disparities in Use of Continuous Glucose Monitoring.

Numerous studies have demonstrated that use of continuous glucose monitoring (CGM) improves glycemic control and reduces diabetes-related hospitalizations and emergency room service utilization in individuals with diabetes who are treated with intensive insulin regimens. Recent studies have revealed disparities in use of CGM within racially and ethnically diverse and lower socioeconomic populations, leading to underutilization of CGM in these populations. This article reviews the scope and impact of these disparities on utilization of CGM and explores the factors that may be contributing to this issue.

Continuous Glucose Monitoring (CGM) Is a Tool, Not a Reward: Unjustified Insurance Coverage Criteria Limit Access to CGM.

Recent studies have demonstrated the clinical utility of continuous glucose monitoring (CGM) use in type 2 diabetes (T2D) patients who are treated with intensive insulin management. Large retrospective database analyses of T2D patients treated with less-intensive therapies have also shown that CGM use was associated with significant reductions in hemoglobin A1c levels and health resource utilization, including diabetes-related hospitalizations and emergency room care. Despite the growing body of evidence supporting CGM use in the broader T2D population, current eligibility criteria required by public and many private insurers are denying millions of individuals with T2D access to this valuable technology. In this article, we discuss an evidence-based rationale for modifying current eligibility requirements for CGM coverage.