Comparative- and Cost-Effectiveness of Continuous Glucose Monitoring for Type 1 Diabetes.

摘要

Type 1 diabetes (T1D) patients are prescribed self-monitoring of blood glucose (SMBG) with insulin injections to reduce hemoglobin A1c and protect against life-threatening complications. In restricted clinical trial populations, evidence shows continuous glucose monitoring (CGM) devices can reduce A1c further. However, little evidence exists on the use of CGM in clinical practice. The objective was to estimate the adherence, change in A1c, and cost associated with using CGM compared to SMBG alone in a clinical practice setting.;I retrospectively identified 66 adult T1D patients at the University of Colorado Barbara Davis Center for Diabetes who first initiated CGM from 2006 to 2011 and 67 controls using SMBG. 12 months prior to index date was the baseline period with a maximum follow-up of 9-months post index. Adherence and outcomes were assessed from survey recall and medical record data. The short-term change in A1c and costs were projected over a lifetime of CGM use, and costs and quality-adjusted life years (QALYs) were reported for both treatment arms.;Baseline mean (SD) age in years for CGM vs. SMBG was 39 (12) vs. 32 (12) (p<0.05); duration of diabetes in years was 23 (12) vs. 15 (10) (p<0.05); A1c was 7.47% vs. 7.67% (p=0.30). N=32 (48%) used CGM < 21 days/month. The between group mean difference in change in A1c, adjusted for demographics, was -0.12% (p = 0.36), whereas the subgroup with a baseline A1c ≥ 7.5% and users of CGM ≥ 21 days/month was -0.49% (p = 0.10). When projected over the long-term, CGM use for the overall cohort and subgroup (CGM use ≥ 21 days/month and A1c ≥ 7.5%) added cost and QALYs when compared to SMBG alone, however the subgroup provided a better value of ;These clinical practice CGM data suggest a trend towards decreasing A1c for adults with T1D, especially in patients with higher baseline A1c and higher CGM adherence. Compared to SMBG alone, CGM provides better value for money when patients are adherent with higher A1c. More data are needed on how to efficiently target CGM therapy in clinical practice.