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  • Assessing Patterns of Continuous Glucose Monitoring Use and Metrics of Glycemic Control in Type 1 Diabetes and Type 2 Diabetes Patients in the Veterans Health Care System: Integrating Continuous Glucose Monitoring Device Data with Electronic Health Records Data
Title: Assessing Patterns of Continuous Glucose Monitoring Use and Metrics of Glycemic Control in Type 1 Diabetes and Type 2 Diabetes Patients in the Veterans Health Care System: Integrating Continuous Glucose Monitoring Device Data with Electronic Health Records Data
Award ID(s):
2205441 2054253
PAR ID:
10616924
Author(s) / Creator(s):
; ; ; ; ;
Publisher / Repository:
Mary Ann Liebert, Inc.
Date Published:
Journal Name:
Diabetes Technology & Therapeutics
Volume:
26
Issue:
11
ISSN:
1520-9156
Page Range / eLocation ID:
806 to 813
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
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  1. ; ; ; ; ; ; (, Diabetes Technology & Therapeutics)
  2. ; ; ; ; ; ; ; ; ; (, Journal of Diabetes Science and Technology)
    Background:Achieving optimal glycemic control for persons with diabetes remains difficult. Real-world continuous glucose monitoring (CGM) data can illuminate previously underrecognized glycemic fluctuations. We aimed to characterize glucose trajectories in individuals with Type 1 and Type 2 diabetes, and to examine how baseline glycemic control, CGM usage frequency, and regional differences shape these patterns. Methods:We linked Dexcom CGM data (2015–2020) with Veterans Health Administration electronic health records, identifying 892 Type 1 and 1716 Type 2 diabetes patients. Analyses focused on the first three years of CGM use, encompassing over 2.1 million glucose readings. We explored temporal trends in average daily glucose and time-in-range values. Results:Both Type 1 and Type 2 cohorts exhibited a gradual rise in mean daily glucose over time, although higher CGM usage frequency was associated with lower overall glucose or attenuated increases. Notable weekly patterns emerged: Sundays consistently showed the highest glucose values, whereas Wednesdays tended to have the lowest. Seasonally, glycemic control deteriorated from October to February and rebounded from April to August, with more pronounced fluctuations in the Northeast compared to the Southwest U.S. Conclusions:Our findings underscore the importance of recognizing day-of-week and seasonal glycemic variations in diabetes management. Tailoring interventions to account for these real-world fluctuations may enhance patient engagement, optimize glycemic control, and ultimately improve health outcomes. 
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  3. ; ; ; ; ; (, Diabetes Care)
    OBJECTIVETo determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events. RESEARCH DESIGN AND METHODSA retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months. RESULTSCGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (−0.26%; 95% CI −0.33, −0.19%) and T2D (−0.35%; 95% CI −0.40, −0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c <8 and <9% after 12 months were greater in CGM users. In T1D, CGM initiation was associated with significantly reduced risk of hypoglycemia (hazard ratio [HR] 0.69; 95% CI 0.48, 0.98) and all-cause hospitalization (HR 0.75; 95% CI 0.63, 0.90). In patients with T2D, there was a reduction in risk of hyperglycemia in CGM users (HR 0.87; 95% CI 0.77, 0.99) and all-cause hospitalization (HR 0.89; 95% CI 0.83, 0.97). Several subgroups (based on baseline age, HbA1c, hypoglycemic risk, or follow-up CGM use) had even greater responses. CONCLUSIONSIn a large national cohort, initiation of CGM was associated with sustained improvement in HbA1c in patients with later-onset T1D and patients with T2D using insulin. This was accompanied by a clear pattern of reduced risk of admission to an emergency room or hospital for hypoglycemia or hyperglycemia and of all-cause hospitalization. 
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  4. ; ; ; ; ; ; ; ; ; (, Journal of Diabetes Science and Technology)
    Background:Youth with type 1 diabetes (T1D) and public insurance have lower diabetes technology use. This pilot study assessed the feasibility of a program to support continuous glucose monitor (CGM) use with remote patient monitoring (RPM) to improve glycemia for youth with established T1D and public insurance. Methods:From August 2020 to June 2023, we provided CGM with RPM support via patient portal messaging for youth with established T1D on public insurance with challenges obtaining consistent CGM supplies. We prospectively collected hemoglobin A1c(HbA1c), standard CGM metrics, and diabetes technology use over 12 months. Results:The cohort included 91 youths with median age at enrollment 14.7 years, duration of diabetes 4.4 years, 33% non-English speakers, and 44% Hispanic. Continuous glucose monitor data were consistently available (≥70%) in 23% of the participants. For the 64% of participants with paired HbA1cvalues at enrollment and study end, the median HbA1cdecreased from 9.8% to 9.0% ( P < .001). Insulin pump users increased from 31 to 48 and automated insulin delivery users increased from 11 to 38. Conclusions:We established a program to support CGM use in youth with T1D and barriers to consistent CGM supplies, offering lessons for other clinics to address disparities with team-based, algorithm-enabled, remote T1D care. This real-world pilot and feasibility study noted challenges with low levels of protocol adherence and obtaining complete data in this cohort. Future iterations of the program should explore RPM communication methods that better align with this population’s preferences to increase participant engagement. 
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  5. ; ; ; ; ; ; ; ; ; ; et al (, Diabetes, Obesity and Metabolism)
    Abstract AimsPsychosocial impacts of early continuous glucose monitoring (CGM) initiation in youth soon after type 1 diabetes diagnosis are underexplored. We report parent/guardian and youth patient‐reported outcomes (PROs) that measure psychosocial states for families in 4T Study 1. Materials and MethodsOf the 133 families in the 4T Study 1, 132 parent/guardian and 66 youth (≥11 years) were eligible to complete PROs. PROs evaluated included diabetes distress, global health, diabetes technology attitudes and CGM benefits/burden scales. Temporal trends of PROs were assessed via generalised linear mixed effects regression. Sociodemographic and clinical characteristics associated with PROs were evaluated. Psychosocial associations were evaluated by regressing parental distress on youth distress. ResultsPRO completion rates were 85.6% and varied between parent/guardian and youth. Throughout the study, parent/guardian and youth distress remained low and youth had increased technology acceptance (p = 0.046). Each additional month of CGM use was associated with a 14% decrease in the odds of experiencing diabetes distress (aOR = 0.86, 95% CI [0.76, 0.99],p = 0.029). Additionally, higher time‐in‐range was associated with decreased diabetes distress (p = 0.048). Age, diabetic ketoacidosis at diagnosis, gender, ethnicity, insurance status and language spoken were not associated with PROs. ConclusionsInitiation of CGM shortly after type 1 diabetes diagnosis does not have unintended negative psychological consequences. Longer duration of CGM use was associated with decreased youth distress and technology acceptance increased throughout the study. 
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