Article / Publication
Among semaglutide users with T2D, use of CGM was associated with greater decreases in A1c compared to non-CGM users, regardless of insulin therapy. Reductions in A1c were greater for CGM users (-0.85%) compared to the control group (-0.29%) in the overall cohort (differences-in-differences (DID), -0.55%, P<0.0001). The proportion of CGM and semaglutide users who met the ADA target of A1c <7% nearly doubled compared to baseline. The proportion of CGM and semaglutide users who met the HEDIS target of A1c <8% increased by more than 50% compared to 12% for non-CGM users. These results suggest an additive effect of CGM and semaglutide, and their combined use could help more people with T2D reach their glycemic targets. The possible mechanisms underlying the additive benefit between CGM and semaglutide could include improved diabetes management self-efficacy (related to diet, exercise, and medication adherence) and more effective medication titration. CGM may enhance patient understanding and management of T2D, including those on GLP-1s.
Learn MoreCGM use was associated with -0.62% A1c reduction at 3 months in people with diabetes on basal only or non-insulin therapies in the primary care setting. CGM use significantly improved glycemic control in T2D patients irrespective of treatment regimen (non-insulin or basal insulin). This study was conducted in collaboration with the American Medical Group Association (AMGA).
Learn MoreAn expert panel of 4 payer and 6 provider stakeholders was convened to discuss opportunities for CGM-based care management in risk-sharing agreements between payers and providers. The panelists were surveyed before 2 virtual roundtable meetings, during which pertinent clinical and trend data were shared.
All payer participants cited using interdisciplinary care management for type 2 diabetes (T2D) and 50% used a digital health platform, but only 25% featured an integrated CGM component. All payer participants responded that “fingerstick” glucose management was either inadequate or questionable for use in current care management programs for T2D. Conversely, 100% also responded that CGM would improve their care delivery solutions. These findings were published as an abstract in the Journal of Managed Care and Specialty Pharmacy and presented in a poster at the 2025 Academy of Managed Care Pharmacy Annual Meeting, including parameters for optimizing risk-sharing agreements incorporating CGM. Specifically, the expert panelists outlined 3 key elements of risk-sharing agreements: agreement design, realistic outcomes measures, and strategies to facilitate payer and provider participation. The recommendations provided by the panel may be valuable for managed care and payer decision makers in shaping risk-sharing agreements to advance the utilization of CGM and improve member outcomes in the management of T2D.
Albright J, McCormick D, Pourarsalan H, Pangrace M. Payer-Provider Risk-Sharing Agreements to Advance Continuous Glucose Monitoring–Based Care in Type 2 Diabetes. Presented at the AMCP Annual Meeting; Houston, TX: April 2, 2025. [Poster E6.]
Learn MoreThe Ohio Diabetes Quality Improvement Project (QIP), focused on multisector collaborative approaches, reduced the percentage of patients with A1c >9% from 25% to 20% over two years. In response to barriers voiced by providers and patients, Medicaid payers added coverage for diabetes self-management education and removed prior authorization requirements for continuous glucose monitoring (CGM) within select populations. These efforts enhanced equity to Medicaid enrollees by making it easier to obtain and afford diabetes management supplies and resources.
Learn MoreAs many health plans transition to a value-based diabetes care approach, there is a need for standardized quality measures to assess and benchmark performance. This article addresses key topics to support the adoption of continuous glucose monitoring (CGM) technology in these efforts.
- Transition from Fee-for-Service to Value-Based Care
- Integration of Glucose Management Indicator (GMI) into 2024 NCQA HEDIS Measures
- Impact of CGM on Health Plan Quality Scores & Reimbursement
- Call for Health Systems and Plans to Collaborate with Electronic Health Record Developers
A retrospective observational study using Aetna administrative claims data showed that CGM use was associated with clinically meaningful improvements in A1c and reduced health care resource utilization. The study, published in the Journal of Managed Care and Specialty Pharmacy, looked at a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and coverage for medical and pharmacy benefits. Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) showed a significant improvement in A1c after CGM initiation (-0.7%, P<0.0001), including a -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (P<0.0001 for both). This real-world analysis suggests a potential for population-level clinical and economic benefits with CGM in a managed care setting, particularly among patients not using insulin.
Learn MoreA retrospective claims analysis of 74,679 adults with T2D showed significant reductions in all-cause hospitalizations, acute diabetes-related hospitalizations, and acute diabetes-related emergency room visits associated with CGM use. These sizeable reductions in health care resource utilization were observed in patients treated with non-insulin therapy (NIT; -10.1%, -31.0%, -30.7%), basal insulin therapy (BIT; -13.9%, -47.6%, -28.2%), and prandial insulin therapy (PIT; -22.6%, -52.7%, -36.6%, respectively) across the 6 to 12 month post-index period. Mean HbA1c was likewise reduced across all treatment types at approximately 3 months and sustained throughout the post-index period (NIT, -1.1%; BIT, -1.1%; and PIT, -0.9%; P< 0.0001).Study authors noted that these findings support expanded coverage of CGM use for people with T2D regardless of treatment type to improve glycemic control and reduce hospitalizations and overall health care costs. Furthermore, the study suggests that managed care and payer decision makers can benefit from consideration of CGM use in patients with T2D who are often ineligible for coverage as a means of managing the total cost of care.
Garg SK, Hirsch IB, Repetto E, Snell-Bergeon J, Ulmer B, Perkins C, Bergenstal RM. Impact of continuous glucose monitoring on hospitalizations and glucose control in people with type 2 diabetes: real-world analysis. Diabetes Obes Metab. September 12, 2024. doi: 10.1111/dom.15866. Epub ahead of print.
Learn MoreClinical practice guidelines endorse the use of CGM, and CMS recently expanded coverage for this technological intervention. However, disparities due to racial/ethnic bias, insurance coverage, and healthcare literacy present barriers to equitable diabetes care and access to CGM. Data show that members of minority populations, those with lower socioeconomic status and those without private insurance are disproportionately affected by diabetes and have lower rates of CGM use. This article, published in Managed Healthcare Executive, notes that payers should place greater emphasis on expanding patient education programs. In addition, further action must be taken to inform patients and to increase adoption and dissemination of new diabetes care technology. In addition to enhancing provider knowledge of CGM and its role in optimal patient care, managed care and payer professionals are tasked with ensuring that unnecessary barriers do not exist in current coverage policies.
In an accompanying video series, Estay Greene, PharmD, MBA, provides insights on ways to improve the care of patients with diabetes from the payer persepective, with a focus on data supporting the use of CGM. Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, FADCES, FCCP, and David Hines also share their perspectives on social determinants of health in diabetes management and overcoming disparities in care with appropriate use of CGM.
Learn MoreThis article provides a comprehensive summary of the latest discoveries in the category of continuous glucose monitoring (CGM). It compiles the most recent scientific findings in an easy-to-read format, complete with hyperlinks and QR codes to full-text articles and abstracts. Read here to learn how increased implementation and expanded access to CGM may improve clinical and economic outcomes and reduce diabetes-related healthcare utilization and costs.
Key Topics:
- 2024 Clinical Practice Updates and Quality Measure Changes
- Emerging Evidence for CGM Use in Non-Intensively Treated Type 2 Diabetes
- Reduction in Healthcare Resource Utilization and Mortality
- Real-World Data Showing CGM Reduces Costs
- Utilization of GLP-1 Agonists in Conjunction with CGM
A poster presented at the Academy of Managed Care Pharmacy’s (AMCP) annual meeting in New Orleans, LA, shared data from a health initiative by Metro Nashville Public Schools. The employer provided CGM devices as a pharmacy benefit without prior authorization. This policy change led to a two-fold increase in CGM utilization among employees aged 18 to 64 years with T1D and T2D regardless of treatment regimen. The retrospective analysis, covering 184 participants, showed significant improvements in glycemic control associated with CGM use. Specifically, average A1c decreased from 8.7% to 7.9% and from 7.6% to 6.8% among those with T2D treated with insulin and not-treated with insulin, respectively. Additionally, CGM use resulted in a significant improvement in the proportion of individuals meeting the HEDIS and ADA HbA1c targets of <8.0% and <7.0%, respectively. These results underscore the potential benefits of CGM for improving diabetes management through streamlined health care payer and purchaser coverage.
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