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Continuous Glucose Monitoring

Education for Managed Care, Pharmacy, and Payer Professionals

Real-World Evidence

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A CGM Expert Interview With Thomas Grace, MD

In a video interview, Dr. Thomas Grace, Medical Director at the Blanchard Valley Diabetes Center in Findlay, Ohio, describes the clinical utility of using rtCGM in a primary care setting and the steps taken to implement a rtCGM-centered management program in his clinic. Dr. Grace also details the expansion of the rtCGM program to employees with diabetes, implemented through a partnership with a locally based Fortune 500 company. If you are a health plan care manager or if your role involves population health management, you won’t want to miss the progressive, value-driven approach shared by Dr. Grace and the ROI derived from rtCGM data and enhanced patient experience.

Short on time? Click here for an abbreviated version.

Real-Time Continuous Glucose Monitor (RTCGM) Use Associated with Decreased Diabetes Medical Costs for Patients with Type 2 Diabetes (T2D)

Source: Digital Technology and Therapeutics

Key Takeaway: A retrospective analysis of administrative claims data from the Optum Research Database showed rtCGM use was associated with diabetes-related medical cost reductions in patients with T2D. Increased access to rtCGM for patients with T2D may help to reduce diabetes-related cost of care.

Diabetes-related Medical Care Costs Decreased $424 PPPM After Initiating rtCGM Treatment

Real-Time Continuous Glucose Monitor (RTCGM) Use Associated with Decreased Diabetes Medical Costs for Patients with Type 2 Diabetes (T2D)

*PPPM = per patient per month

Association of Real-time Continuous Glucose Monitoring With Glycemic Control and Acute Metabolic Events Among Patients With Insulin-Treated Diabetes

Source: The Journal of the American Medical Association

Key Takeaways: Continuous Glucose Monitoring improved outcomes more than intermittent testing of blood glucose in 41,753 patients with insulin-treated diabetes.

“Our real-world study found that in patients with insulin-treated diabetes, initiating a continuous glucose monitor substantially improved blood glucose control and cut the rate of emergency room visits for hypoglycemia in half.”1 

Andrew J. Karter, PhD, Senior Research Scientist at Kaiser Permanente Division of Research

Continuous Glucose Monitoring improved outcomes more than intermittent testing of blood glucose in 41,753 patients with insulin-treated diabetes.


1Shaffer R. Real-time CGM lowers HbA1c, reduces ED visits in insulin-treated diabetes. Endocrine Today. June 2021. Accessed June 24, 2021.

Change in HbA1c and Quality of Life with Real-time CGM Use by People with Insulin-Treated Diabetes in the Landmark Study

Source: Diabetes Technology and Therapeutics

Key Takeaway: The Landmark study demonstrated significant glycemic and QoL benefits for first time CGM use among individuals using intensive insulin therapy to manage either T1D or T2D. After approximately 12 weeks of Dexcom G6 use, participants had a mean absolute reduction in HbA1c levels of 1.1%, and more than half of those with initial HbA1c values >7% experienced absolute HbA1c reductions of >1%. The reduction in HbA1c observed in Landmark was similar for patients with T1D and T2D and was more pronounced for participants with higher baseline HbA1c, consistent with observations from the DIAMOND randomized controlled trial. Significant reductions in diabetes distress and hypoglycemic concerns were also observed. In the Landmark study, there was no standardized training or intervention at CGM initiation, suggesting that the glycemic benefits can be realized without formal instruction.

Changes in HbA1c according to baseline HbA1c level


Remote Application and Use of Real-Time Continuous Glucose Monitoring by Adults with Type 2 Diabetes in a Virtual Diabetes Clinic

Source: Diabetes Technology & Therapeutics

Key Takeaway:  The role of real-time continuous glucose monitoring (rtCGM) is an essential component of telemedicine visits for people with diabetes. This observational study demonstrated that people with type 2 diabetes (T2D) participating in a virtual diabetes clinic can successfully insert and use Dexcom rtCGM without in-office training. The use of rtCGM was associated with a significant improvement in HbA1c at 10 months in those not meeting the ADA treatment target, independent of insulin use. In addition, there was a large shift in the percentage of participants meeting the HEDIS HbA1c target of <8.0% at follow-up; this may have important clinical and economic implications.  

Chart: Percentage of Participants Achieving HEDIS HbA1c Treatment Target (HbA1c <8.0%) Before and After rtCGM Use

Continuous Glucose Monitoring in Adults with Type 1 Diabetes: Real-World Data from the German/Austrian Prospective Diabetes Follow-Up Registry


Key Takeaway: Real-world data from the German/Austrian Prospective Diabetes Follow-Up Registry showed real-time continuous glucose monitoring was associated with a higher percentage of Time-in-Range and improved metabolic stability as compared to intermittent scanning continuous glucose monitoring.

Uninterrupted Continuous Glucose Monitoring Access is Associated with a Decrease in HbA1c in Youth with Type 1 Diabetes and Public Insurance


Key Takeaway: In a Medicaid population of youth with Type 1 Diabetes, uninterrupted continuous glucose monitoring (CGM) use was associated with improvements in hemoglobin A1c. Interruptions in use—primarily due to gaps in insurance coverage of CGM—were associated with increased hemoglobin A1c, supporting initial and ongoing CGM coverage in high-risk, publicly insured demographics.

Demonstrating the Clinical Impact of Continuous Glucose Monitoring Within an Integrated Healthcare Delivery System


Key Takeaway:  Recent data from a prospective, randomized study conducted by Intermountain Health suggests that real-time CGM can reduce healthcare utilization and decrease the overall cost of care compared to SMBG. Participants reported that real-time CGM data were helpful in modifying their nutrition, physical activity, stress, and medication adherence.  

Improved well-being and decreased disease burden after 1-year use of flash glucose monitoring (FLARE-NL4)

Source: BMJ Open Diabetes Research and Care

Key takeaway: A real-life observational study demonstrated the effectiveness of flash glucose monitoring (FGM) in participants with diabetes over a 12 month period.  Data from the Netherlands Nationwide Registry showed the use of FGM results in improved well-being, decreased disease burden, and is associated with a 0.4% reduction of HbA1c after 12 months (p < 0.001).  Results from a patient-reported outcome measures questionnaire revealed significant reductions in work absenteeism and diabetes-related hospital admissions. 

Glycemic Outcomes with Early Initiation of Continuous Glucose Monitoring System in Recently Diagnosed Patients with Type 1 Diabetes

Source: Diabetes Technology & Therapeutics

Key Takeaway: CGM initiated within the first year of T1D diagnosis was effective in lowering and maintaining A1C for 2.5 years and reduced the frequency of ED visits related to hypoglycemia and hyperglycemia irrespective of insulin delivery method.

Effect of Continuous Glucose Monitoring on Glycemic Control, Acute Admissions, and Quality of Life: A Real-World Study

Source: The Journal of Clinical Endocrinology & Metabolism

Key Takeaway: Nationwide reimbursement of real-time CGM improved HbA1c, fear of hypoglycemia, and QOL as well as economic indicators including work absenteeism and hospital admissions for acute diabetes complications.

The Value of rtCGM: Reduction in Hospitalizations and Work Absenteeism
  Pre-Reimbursement for rtCGM Post-Reimbursement for rtCGM P Value
  (n = 496) (n = 379)  
Patients with      
    Hospitalizations due to hypoglycemia and/or ketoacidosis 77 (16%) 14 (4%) <0.0005
    Hospitalizations due to hypoglycemia 59 (11%) 12 (3%) <0.0005
    Hospitalizations due to ketoacidosis 23 (5%) 4 (1%) 0.092
    Work absenteesim* 123 (25%) 36 (9%) <0.0005
Days (per 100 patient years) of       
    Hospitalizations due to hypoglycemia and/or ketoacidosis 53.5 17.8 <0.0005
    Hospitalizations due to hypoglycemia 38.5 12.5 0.001
    Hospitalizations due to ketoacidosis 14.9 5.3 0.220
    Work absenteeism 494.5 233.8 0.001

Data are n (%).

*Work absenteeism of at least half a day. Patient-reported hospital admissions were validated by clinicians.

Reference: Charleer S, et al. Clin Endocrinol Metab. 2018;103(3):1224–1232

The Value of rtCGM: Improved Population Glycemic Control

Reference: Charleer S, Mathieu C, Nobels F, et al. J Clin Endocrinol Metab. 2018;103(3):1224-1232.

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