The following is the summary of “Assessment of Glucose Monitoring Adherence in Medicare Beneficiaries with Insulin-Treated Diabetes” published in the December 2023 issue of diabetes technology and therapeutics by Puckrein, et al.
Patients on intensive insulin therapy were studied to determine the effect of adherence to prescribed glucose monitoring on inpatient admissions and associated expenses, as well as the potential role of race and ethnicity. A retrospective study was conducted from January 2018 to December 2018 using data from the Centers for Medicare & Medicaid Services to identify Medicare enrollees who received intensive insulin therapy. People who (1) utilize rtCGM, (2) stick to their prescribed use patterns while using any type of blood glucose monitor (BGM), (3) were prescribed BGM but did not use it as directed, and (4) had no record of using any type of BGM.
Comorbidities (as measured by the Charlson Comorbidity Index [CCI]), as well as race and ethnicity, were analyzed in relation to group assignment, inpatient admissions for diabetes-related complications, and healthcare expenses. Among the total sample size of 1,329,061 people, 38.14% did not have any documented instances of glucose monitoring, and 35.42 % did not adhere to the BGM. Similar to the above, 466,646 (74.13%) of the 629,514 beneficiaries with a CCI risk score of ≥2 were either non-adherent to BGM or had no monitoring record. (P<0.0001) shows that White rtCGM adherent beneficiaries (3.65%) are more numerous than Black (1.58%) or Hispanic (1.28%) rtCGM adherent beneficiaries.
Regardless of glucose monitoring technique, the rate of hospitalizations and total costs for beneficiaries of color in the risk score ≥2 category were greater than for Whites. The lack of any BGM was associated with greater rates of comorbidities, and hospitalizations and the expenditures of caring for people with diabetes were higher among people of color. Medicare’s coverage did not increase the use of rtCGM among people of color. To raise glucose monitoring rates among Medicare’s diabetic population, new programs promoting self-management education and support services are required.