January 6, 2023
Clinical Outcomes
Guidelines / Policy

The 2023 Standards of Medical Care in Diabetes found Grade A evidence supporting the use of RT-CGM in adults with T1D or T2D on intensive insulin therapy and in adults with T2D on basal insulin. The American Diabetes Association (ADA) found Grade B evidence supporting the use of RT-CGM in children and adolescents with T1D on intensive insulin therapy and Grade E evidence for use of RT-CGM in children and adolescents with T2D on intensive insulin therapy. When used as an adjunct to pre- and postprandial BGM, RT-CGM can help to achieve HbA1c targets in pregnant patients with diabetes (Grade B). Based on input from experts, the ADA recommends continued access to RT-CGM through third party payers to people who have been using this technology.

American Diabetes Association. 7. Diabetes Technology: Standards of Care in Diabetes—2023. Diabetes Care. 2022; 46(Suppl 1):S111-S27.

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January 1, 2023
Coverage and Benefit Design
Guidelines / Policy

Effective January 1, 2023, UnitedHealthcare (UHC) is making selected continuous glucose monitoring (CGM) devices and sensors available to Medicare Advantage members at the pharmacy point-of-sale (POS). The systems affected by this change in policy include the Dexcom G6 as well as the FreeStyle Libre 2 and 14-day versions. CGMs were previously only available to UHC Medicare Advantage members through national durable medical equipment (DME) vendors. While availability through DME vendors will remain in place, the plan sought to improve access to CGMs for members by expanding to the pharmacy POS. Managed care decision makers should take note of this change in policy as an example of how national payers are leveraging the pharmacy channel as a means of enhancing coverage and member access to beneficial diabetes technologies.

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December 27, 2022
Clinical Outcomes
Article / Publication
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December 20, 2022
Coverage and Benefit Design
CE Activities

Intended Audience: This activity is designed to meet the educational needs of medical directors, registered nurses, pharmacy directors, clinical pharmacists, specialty pharmacists, quality directors, as well as network physicians affiliated with various MCOs, health systems, and other payer organizations.

Credit Available: Up to 0.5 credit hour available for nurses (ANCC), pharmacists (ACPE), and physicians (AMA PRA Category 1 Credit™)

Expiration Date:  June 30, 2024

Click Here to Begin!

Educational Objectives

  • Describe the clinical impact of real-time continuous glucose monitoring on HbA1c, severe hypoglycemia-related events and diabetic ketoacidosis
  • Assess health plan opportunities to improve HbA1c and diabetes outcomes through implementation of real-time continuous glucose monitoring interventions for patients with diabetes
  • Identify key stakeholders and steps for the delivery of successful quality improvement interventions targeting patients naïve to real-time continuous glucose monitoring

Expert Faculty

Roy Gandolfi, MD

Medical Director

Select Health

Jeffrey Dunn, PharmD, MBA

Chief Clinical Officer

Cooperative Benefits Group

Jointly provided by Impact Education, LLC, and Medical Education Resources.
This continuing education activity is supported by an independent educational grant from Dexcom, Inc.

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December 14, 2022
Clinical Outcomes
CGM Best Practices / Webinar / Archive
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December 13, 2022
Clinical Outcomes
Article / Publication

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
Article / Publication

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
Article / Publication

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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December 9, 2022
Clinical Outcomes
Article / Publication / CGM Innovations

In an analysis of available data, accuracy metrics from preapproval trials of the G5, G6, and G7 real-time continuous glucose monitoring (RT-CGM) systems were compared after propensity score adjustments were applied to balance baseline demographic characteristics. Metrics included mean absolute relative differences (MARD) between CGM and YSI values (from the YSI, Inc., 2300 Stat Plus system) and the proportion of CGM values within 20% or 20 mg/dL of the YSI values (“%20/20”). Ease-of-use was also evaluated by formal task analysis in the study. Accuracy performance of the G7 sensors, whether placed on the arm or abdomen, was similar to that of abdomen-placed G5 and G6 sensors, and egregious errors were rare with all three systems. Based on the formal task analysis, the authors concluded that simplification of the sensor insertion process should result in G7 being even easier to learn and several software improvements may contribute to better glycemic outcomes. Payer professionals may well find confidence in the comparative usability data for the latest RT-CGM system versus previous versions of the technology when considering updates to coverage policies.

Welsh JB, Psavko S, Zhang X, Gao P, Balo AK. Comparisons of Fifth-, Sixth-, and Seventh-Generation Continuous Glucose Monitoring Systems. J Diabetes Sci Technol. 2022:19322968221099879.

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December 9, 2022
Clinical Outcomes
Article / Publication / CGM Innovations

In children and adolescents with type 1 diabetes (T1D), the G7 real-time continuous glucose monitoring (RT-CGM) system demonstrated accuracy across wear days, glucose ranges, and rates of glucose change. Over 10.5 days, RT-CGM data from 28 participants aged 2 to 6 years and 127 participants aged 7 to 17 were collected and compared with blood glucose measurements. In young children aged 2 to 6, overall MARD and %20/20 agreement rates were 9.3% and 91.5%, respectively. In older children and adolescents aged 7 to 17 years, arm- and abdomen-placed G7 sensor MARD values were 8.1% and 9.0%, respectively, and overall %20/20 values were 95.3% and 92.9%, respectively. These results are consistent with those of the G6 system in children and adolescents with T1D and with an earlier study of the G5 system that evaluated accuracy at different insertion sites. Compared with the G6 RT-CGM system, the G7 has a shorter warm-up period (27 minutes vs 2 hours), making it possible for youth and caregivers of young children to obtain glucose data more quickly for diabetes management decisions. According to the authors, while day 1 accuracy tends to be lower across CGM devices, the accuracy of the G7—coupled with its shorter warm-up period—should improve the sensor experience in young users. The G7 RT-CGM was recently FDA approved for use in all individuals with diabetes aged 2 years and older, and having data specific to use in children and adolescents can be of value for managed care and payer professionals in developing coverage policies.

Laffel LM, Bailey TS, Christiansen MP, Reid JL, Beck SE. Accuracy of a Seventh-Generation Continuous Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes. J Diabetes Sci Technol. 2022:19322968221091816.

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