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January 18, 2023
Clinical Outcomes
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International diabetes experts recently collaborated to provide recommendations on how to optimize CGM-derived glucose data collection in clinical studies, including the specific glucose metrics and specific glucose metrics that should be evaluated. These consensus recommendations have been endorsed by key professional organizations, including the American Association of Clinical Endocrinologists, the American Diabetes Association, the Association of Diabetes Care and Education Specialists, Diabetes India, the European Association for the Study of Diabetes, the International Society for Pediatric and Adolescent Diabetes, the Japanese Diabetes Society, and the Juvenile Diabetes Research Foundation. This recommended standardized approach to CGM data collection and reporting in clinical trials will encourage the use of uniform metrics and enhance the interpretability of CGM data. Managed care and payer professionals should note that these metrics offer a body of useful information beyond HbA1c to inform therapeutic and treatment decisions, particularly related to hypoglycemia, postprandial hyperglycemia, and glucose variability.

Battelino T, Alexander CM, Amiel SA, et al. Continuous glucose monitoring and metrics for clinical trials: an international consensus statement. Lancet Diabetes Endocrinol. 2023;11:42-57.

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January 18, 2023
Coverage and Benefit Design
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Pharmacy professionals and a payer representative convened an expert panel to connect available evidence and the panelists’ extensive experiences on the value of RT-CGM in improving patient quality of life. In addition, the panelists provided prac­tical approaches to bring awareness, accessibility, and the utility of rtCGM to positively impact patient quality of life in practical applications. Managed care and payer professionals will find these real-world insights useful in characterizing the value of RT-CGM in health plan populations when making coverage determinations.

Real-Time Continuous Glucose Monitoring: Timely Opportunities to Improve Quality of Life.” CGM Live Virtual Crossfire Series Recap. Part 2. Pharmacy Times Continuing Education. August 2021.

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January 18, 2023
Coverage and Benefit Design
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An expert panel composed of pharmacists and a payer professional discussed the value of RT-CGM and the role pharmacists and pharmacy technicians have in optimizing diabetes management. By making RT-CGM available to and allowing pharmacy professionals to work alongside patients, health care stakeholders can leverage the information offered by this technology to optimize diabetes management and mitigate disease impact. The panelists noted that coverage of RT-CGM through the pharmacy benefit facilitates access by allowing patients to fill their prescription directly at community pharmacies. The panelists’ insights are of use to managed care and payer professionals in determining optimal coverage policies for RT-CGM to improve outcomes among members with diabetes.

“Real-Time Continuous Glucose Monitoring: Implications for Pharmacists.” CGM Live Virtual Crossfire Series Recap. Part 1. Pharmacy Times Continuing Education. May 2021.

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January 18, 2023
Coverage and Benefit Design
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A roundtable convened by the American Pharmacists Association reviewed the substantial body of evidence demonstrating that CGM is associated with improved glycemic control for patients with both T1D and T2D. Leading experts participating in the roundtable noted that CGM remains underutilized and that disparities in care are evident. One specific barrier to expanded utilization called out by the participants was the lack of an adequate number of providers who offer the service. Developing community pharmacy-based CGM services has been proposed as a logical solution for expanding patient access. Supporting this approach are the abundant data showing that pharmacist involvement in patient care for diabetes improves outcomes and reduces overall costs of care. Managed care and payer professionals will find this in-depth review and discussion valuable for developing their own policies for CGM coverage and access in the pharmacy setting.

American Pharmacists Association Foundation. “Expanding Access to Continuous Glucose Monitoring Technology in Community Pharmacies.” Practices Insights. May 2022.

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January 18, 2023
Population Health
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According to a survey administered by Employee Benefit News, at least 70% of employees find high stress, depression, asthma, or diabetes disruptive enough to affect their everyday lives, including work and other responsibilities. In response, the vast majority of employers (84%) are offering digital health tools in some form that can help employees manage common chronic conditions, although only an average of 50% of employees take advantage of these benefits. Research shows employees want flexible options that offer new innovative tools to treat their chronic conditions, in addition to education to help them get started with a new program. Third-party technology vendors can assist in driving employee engagement, mitigating rising health care costs, and creating better outcomes for employees. Managed care and payer professionals will find these insights useful for developing programs that offer value to purchasers of health care.

“Optimizing Digital Health Tools to Retain and Engage Employees.” Employee Benefit News Supplement.

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December 13, 2022
Clinical Outcomes
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During a session at the 20th World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease held in December, Dr. Peter Reaven discussed the benefits of continuous glucose monitoring (CGM) beyond improved glycemic control. In an analysis of electronic health records from adults with type 1 diabetes (T1D) and type 2 diabetes (T2D) seen in Veterans Affairs (VA) clinics, use of CGM was associated with superior HbA1c reduction and a lower risk of hospitalization. The cohort included >50,000 adults with T1D or T2D who were either CGM users or non-users. CGM users with T1D had a lower risk of admissions to emergency rooms or hospitals for hypoglycemia-related events (HR=0.69 95% CI, 0.48, 0.98; P=0.04), a lower risk of hypoglycemia events in general (HR=0.72; 95% CI, 0.57-0.91; P=0.01), and a lower risk of all-cause hospitalization (HR=0.75; 95% CI, 0.63-0.9; P=0.002) than non-users. CGM users with T2D had a lower risk of hyperglycemia events (HR=0.87; 95% CI, 0.77-0.99; P=0.04) and all-cause hospitalization (HR=0.89; 95% CI, 0.82-0.97; P=0.004) than non-users. In a preliminary analysis, the researchers also calculated mortality risk using propensity score overlap weighting. CGM users with T1D had a lower risk for mortality at 18 months than non-CGM users (adjusted HR=0.38; 95% CI, 0.28-0.51; P<0.001). CGM users with T2D likewise had a reduced mortality risk compared with non-users (aHR=0.79; 95% CI, 0.7-0.88; P<0.001). Dr. Reaven noted that these findings signal a call-to-action for more widespread CGM use, giving managed care and payer professionals cause for consideration in developing coverage policies. 

Reaven P. Presented at: 20th World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease. December 1-3, 2022; Universal City, CA.

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December 9, 2022
Population Health
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In an interview with OBG Management, Dr. Celeste Durnwald explains the benefits of real-time continuous glucose monitoring (RT-CGM) in pregnancy. Risk to fetal, neonatal, and maternal well-being is increased in pregnancy complicated by diabetes. While most patients obtain 7 to 8 glucose values over 24 hours with self-monitoring of blood glucose (SMBG), RT-CGM collects approximately 288 readings daily. In this manner, RT-CGM may help pregnant women align their carbohydrate intake and insulin dosing throughout the day to prevent hyperglycemia while avoiding sudden hypoglycemic events, all without the burden of finger sticks. The CONCEPTT trial showed that only 6 patients would need to use RT-CGM to prevent 1 large-for-gestational-age infant, 8 patients to prevent a case of neonatal hypoglycemia, and 6 patients to prevent a neonatal intensive care unit (NICU) stay. Based on these findings and other published literature, consensus guidelines recommend the use of RT-CGM in pregnant women with pre-existing type 1 and type 2 diabetes, as well as in those with gestational diabetes. These findings offer insights for payer professionals seeking to implement evidence-based quality improvement programs in diabetes or obstetrics.

Durnwald CP. Real-Time Continuous Glucose Monitoring Use in Pregnant Patients From A-to-Z. OBG Management. August 2022.

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December 9, 2022
CGM Technology and Digital Health
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Dexcom G7 is now cleared in the U.S. for people with all Types of diabetes ages two years and older, giving more people than ever access to a powerfully simple diabetes management solution. The next-generation real-time continuous glucose monitoring system demonstrates comparable accuracy to previous versions while offering a smaller sensor and enhanced ease-of-use features.

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