In The News
A retrospective cohort study published in JAMA Network Open showed that CGM use was associated with lower odds of developing diabetic retinopathy (DR) and proliferative diabetic retinopathy (PDR). Among 550 adults with type 1 diabetes (T1D) included in the analysis, 62.7% patients used CGM, 58.2% used an insulin pump, and 47.5% used both. After adjusting for age, sex, race and ethnicity, diabetes duration, microvascular and macrovascular complications, insurance type, and mean HbA1c, CGM was associated with lower odds of DR (odds ratio [OR], 0.52; 95% CI, 0.32-0.84; P=0.008) and PDR (OR, 0.42; 95% CI, 0.23-0.75; P =0.004), compared with no CGM use. These findings show that CGM can be beneficial preventing DR—the leading cause of blindness among adults in the United States—even in individuals with well managed T1D.
Liu TYA, Shpigel J, Khan F, Smith K, Prichett L, Channa R, Kanbour S, Jones M, Abusamaan MS, Sidhaye A, Mathioudakis N, Wolf RM. Use of Diabetes Technologies and Retinopathy in Adults With Type 1 Diabetes. JAMA Netw Open. 2024 Mar 4;7(3):e240728.
Learn MoreThe ADA Standards of Care include all of of the organization’s current clinical practice recommendations and are intended to provide clinicians, patients, researchers, payers, and others stakeholders with best practices in diabetes management, general treatment goals, and tools to evaluate the quality of care. The recommendations are based on an extensive review of the clinical diabetes literature, supplemented with input from ADA staff and the medical community at large. These comprehensive guidelines are updated annually, or more frequently online if new evidence or regulatory changes merit immediate incorporation In alignment with previous versions of the ADA Standards of Care, the 2024 update highlights the clinical benefit of CGM across a wide range of patient types based on a growing body of evidence.
Learn MoreWhile CGM systems were initially prescribed predominantly for patients with T1D, the mounting body of literature and expert recommendations have led to more widespread use in insulin-treated T2D and beyond. Based on RCT and real world evidence supporting CGM use in T2D and published literature demonstrating the utility of CGM in population health, 4 payer and 5 health system experts convened virtually to share their insights on the integration of this technology in current programs. This article provides a review of key evidence discussed by these stakeholders and findings from the meeting, with recommendations for the implementation of T2D population health programs integrating CGM with other interventions.
Learn MoreThis video resource highlights evidence—presented at the 83rd American Diabetes Association (ADA) Scientific Sessions—demonstrating the clinical, economic, and humanistic value of continuous glucose monitoring (CGM) in type 2 diabetes (T2D) for managed care and payer professionals. Abstracts presented in this video underscore the burden of hypoglycemia in T2D and the potential for CGM to improve clinical outcomes and manage disease-related costs regardless of treatment regimen or prescriber type. Key areas of focus pertinent to managed care and payer professionals include the benefits of CGM initiation on Healthcare Effectiveness Data and Information Set (HEDIS) measure performance, utilization of emergency department/hospital services, and patient adherence. This information is delivered in a multimedia infographic format, with quotes from managed care and payer key opinion leaders interspersed for maximum impact. The video concludes with a summary of best practices to facilitate streamlined coverage and access to CGM in alignment with the latest clinical evidence and expert recommendations.
CGM has advanced diabetes management, with demonstrated improvements in glycemic management, reduction of hypoglycemia-related resource utilization, and enhanced member engagement and self-management. While this technology was initially prescribed predominantly for those living with type 1 diabetes (T1D), the mounting body of evidence and expert recommendations have led to more widespread use in insulin-treated T2D, necessitating the implementation of evidence-based benefit design policies by health plans. During this working group meeting, leading payer and managed care decision makers reviewed recent findings and shared their insights on best practices for CGM coverage and reimbursement, including alignment with clinical practice guidelines, availability under the pharmacy benefit, and automated adjudication at the point of sale.
 Jim Kenney, RPh, MBA (Moderator)Founder and President JTKenney, LLC | Clinical Pharmacist, Healthcare and Family Services Bureau of Professional and Ancillary Services University of Illinois at Chicago |
 Thomas Grace, MDMedical Director Blanchard Valley Diabetes Center |  Estay Greene, PharmD, MBAVice President of Pharmacy Zing Health |
 Eric Long, PharmD, MBADisease Management Pharmacist Beacon Health System |  Scott McClelland, PharmDVice President, Commercial and Specialty Pharmacy Programs Florida Blue |
 Josh Moore, PharmDDirector of Pharmacy MO HealthNet Division Missouri Department of Social Services |  Diane E. Morgan, PharmDDirector, Specialty Pharmacy Government Programs Pharmacy UnitedHealthcare  |
 Heather Mullins, PMPSenior Clinical Program Manager UnitedHealthcare |  Susan Wescott, RPh, MBAExecutive Lead, Clinical Services, Alluma, LLC Senior Director of Pharmacy, Managed Care, Mayo Clinic |
In support of this working group, a survey of managed care professionals was conducted. Click here to download the results.
This article reports key findings from recent randomized, observational, and retrospective studies investigating use of CGM in type 2 diabetes (T2D) individuals treated with basal insulin only and/or noninsulin therapies. Data from 29 studies were reviewed and analyzed. Both randomized and prospective/retrospective studies have demonstrated significant glycemic improvement, reductions in diabetes-related events and hospitalization rates, and cost benefits of persistent CGM use by individuals with T2D who are treated with basal insulin only, basal plus noninsulin medications, and noninsulin medications without insulin. In 23 (79%) of the 29 studies reviewed, investigators reported associations between CGM and improvements in HbA1c and/or key CGM metrics. These findings, alone, provide strong evidence that supports providing access to this technology to those with T2D who are less intensively treated. The narrative presents an evidence-based rationale for expanded access to CGM within the T2D basal insulin only and/or noninsulin treated population. Recent clinical guidelines from the American Diabetes Association and American Association of Clinical Endocrinology now endorse CGM use in individuals treated with nonintensive insulin regimens. Access in the basal insulin only population has expanded since the start of this project. CGM should be made readily available to all individuals with diabetes who are able to use this technology safely and effectively.
Learn MoreThis infographic highlights the value of CGM for positively impacting diabetes care quality, with special consideration given to underserved demographics of patients based on race/ethnicity and age. The piece links to the 2023 AMCP symposium moderated by Dr. Gary Puckrein, President and Chief Executive Officer of the National Minority Quality Forum, where diabetes care disparities and quality were also brought into focus. Also linked is an expert interview with Diana Isaacs, PharmD, with insights on disparities in diabetes care and quality considerations. Guidance is offered on improving CGM access as a means for meeting recent HEDIS quality measures tied to reducing emergency department and hospital use. Using findings from Blue Cross Blue Shield North Carolina as a case study, the infographic serves as a call-to-action for payers to remove manual prior authorizations for CGM under the pharmacy benefit.
The Centers for Medicare and Medicaid Services (CMS) expanded CGM access to beneficiaries on basal-only insulin or those with a history of level two or three hypoglycemia. Although the Local Coverage Determination (LCD) was originally anticipated to be implemented in July, CMS expanded access to CGM on April 16, 2023. This new coverage policy is aligned with consensus guidelines from the ADA and AACE, which recommend CGM for all patients on insulin at the outset of diagnosis. The new LCD, which was proposed in 2022, also removes the term “daily” as a descriptor for insulin to account for potential FDA approval of weekly insulins in the future.
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