Evaluation of continuous glucose monitoring outcomes and health care resource utilization in patients with non-insulin-treated type 2 diabetes.

چکیده اصلی

BACKGROUND: Although continuous glucose monitoring (CGM) is well established for insulin-treated diabetes, its utility in non-insulin-treated type 2 diabetes (T2D) remains less studied. OBJECTIVE: To evaluate the short-term clinical and economic outcomes following personal use of CGM in patients with T2D. METHODS: This prospective pre-post study enrolled adults with poorly controlled non-insulin-treated T2D (hemoglobin A1c ≥8%; target N = 200) initiating G7 CGM and observed them for 6 months. Primary endpoints were changes in A1c and Audit of Diabetes-Dependent Quality of Life (ADDQoL) scores. Glycemic events, health care utilization, and medication use were evaluated in a subgroup with claims data. Baseline was defined as the 3 months before CGM initiation. Changes at 3 and 6 months were assessed using the Wilcoxon signed-rank test. Multivariable analysis of covariance models evaluated A1c change, adjusting for baseline A1c and clinical covariates. ADDQoL was analyzed using linear mixed-effects models with random intercepts and fixed effects for time, whereas Cuzick's test assessed quality-of-life trends. RESULTS: Of 217 enrolled patients, a subgroup of 76 had claims data. Most were White (75%) and male (58%), with mean age 58.3±11.5 years. Baseline median A1c was 8.60% (IQR = 8.20-9.10), and mean A1c was 8.96%±1.24%. Prevalent comorbidities included hyperlipidemia (73%), hypertension (70%), and obesity (44%). A1c significantly decreased at 3 and 6 months after CGM (median: -1.10%, -1.40%; mean: -1.28%, -1.42%; P < 0.001). In adjusted models, the adjusted mean change in A1c from baseline was -1.32 percentage points at 3 months (95% CI = -1.48 to -1.15; P < 0.001; n = 153) and -1.48 percentage points at 6 months (95% CI = -1.68 to -1.28; P < 0.001; n = 143). American Diabetes Association (ADA) (<7%) and Healthcare Effectiveness Data and Information Set (HEDIS) (<8%) target attainment improved from 0% at baseline to 26.4% and 50.9% at 6 months (both P < 0.001). Hyperglycemic events declined from 53.7% at baseline to 16.3% at 6 months, although not significantly. No significant changes were observed in health care utilization, medication adherence, or medication burden. Greater CGM use and higher time in range were associated with improved A1c and glucose management indicator outcomes. The proportion reporting good-to-excellent quality of life increased from 24.1% at baseline to 45.8% at 6 months, while weighted ADDQoL scores remained stable. CONCLUSIONS: CGM use in non-insulin-treated patients with T2D was associated with significant improvements in glycemic control and perceived quality of life, with stable health care utilization and medication therapy. These findings support expanded implementation and reimbursement of CGM in this population, but further research is required to assess the long-term sustainability of these improvements and the specific roles of diet, medication, and adherence.

ترجمه فارسی چکیده

اگرچه نظارت مداوم قند خون (CGM) برای دیابت درمان‌شده با انسولین به خوبی تثبیت شده است، کاربرد آن در دیابت نوع ۲ بدون درمان با انسولین کمتر مورد مطالعه قرار گرفته است. هدف این مطالعه ارزیابی نتایج بالینی و اقتصادی کوتاه‌مدت پس از استفاده شخصی از CGM در بیماران مبتلا به دیابت نوع ۲ بود. این مطالعه پیش‌رونده پیش از پس (pre-post) بالغان با دیابت نوع ۲ کنترل‌نشده ضعیف (HbA1c ≥8%) را که شروع به استفاده از CGM مدل G7 کرده بودند، در ۶ ماه مشاهده کرد. نقاط پایانی شامل تغییرات HbA1c و امتیازات ADDQoL بود. رویدادهای قند خون، استفاده از مراقبت‌های بهداشتی و مصرف دارو در یک زیرگروه با داده‌های ادعایی ارزیابی شدند. تغییرات در ۳ و ۶ ماه با آزمون ویلکاکسون رتبه‌ای علامت‌دار ارزیابی شدند. مدل‌های تحلیل کواریانس چندمتغیره تغییرات HbA1c را با در نظر گرفتن HbA1c پایه و متغیرهای بالینی تنظیم کردند. ADDQoL با استفاده از مدل‌های اثرات آمیخته خطی با میانگین‌گیری تصادفی و اثرات ثابت برای زمان تحلیل شد. نتایج نشان داد که HbA1c به طور معناداری پس از CGM کاهش یافت. اهداف ADA و HEDIS بهبود یافتند. رویدادهای هیپرگلیسمی کاهش یافتند. کیفیت زندگی بهبود یافت.

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