medwireNews: Fully subsidizing continuous glucose monitors (CGMs) could overcome disparities in their use by people with diabetes, suggests research conducted in adults enrolled in a US Medicaid program.
“[A]ffordable CGM access and follow-up can help address critical gaps in diabetes management to achieve better long-term health outcomes and disparity reductions for all patients with diabetes,” suggest Rocio Pereira (Denver Health, Colorado, USA) and colleagues, who point out that currently “70% of state Medicaid programs do not cover CGM access for those with type 2 diabetes.”
They looked at CGM uptake and associated glycated hemoglobin (HbA1c) outcomes in 3036 adults with type 2 (n=2794) or type 1 (n=242) diabetes who were on a Medicaid plan that allowed primary care practitioners and endocrinologists to prescribe Freestyle Libre 2 at their discretion without the restrictions imposed by other plans, such as intensity of insulin regimen or number of daily finger-sticks, and the DexcomG6 with prior authorization review.
In all, 628 (20.7%) of the participants were prescribed a CGM, 591 (94.1%) of whom were dispensed a CGM. This same high uptake was seen in both individuals with type 2 and type 1 diabetes.
And the researchers note in Diabetes Care that “[t]here were no significant differences by race/ethnic group—Hispanic; non-Hispanic Black; and Asian, American Indian/Alaskan Native—when compared with non-Hispanic White for the CGM outcomes prescribed, dispensed, more than one fill, and high fill adherence.”
Indeed, Pereira and team report that high fill adherences, based on on a medication possession ratio (MPR) of above 0.9, calculated by the total number of days covered by sensor kits relative to the number of days from when the first sensor was picked up to the data-pull date or the last day of the most recent refill, was particularly notable.
There was even evidence of refills being picked up early by many people – 28% of those with type 2 diabetes and 32% of those with type 1 diabetes – based on an MPR above 1.0.
“These results highlight the broad appeal and sustained interest for all patients with diabetes,” say the investigators, and “suggest that previously noted racial/ethnic disparities to CGM uptake and adherence can largely be overcome by subsidies.”
Factors that did significantly influence CGM uptake included speaking languages other than English (except for Spanish), which lowered the odds for being prescribed and dispensed a CGM and may be due to the CGMs only being available in Spanish and English, which the team says highlights “the need to expand language support.”
By contrast the odds of these outcomes increased for individuals who received endocrine specialty care, and those receiving multiple daily insulin injections versus none. However, endocrine care did not predict high fill adherence, “supporting the role for primary care providers to initiate CGM,” suggest the investigators.
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