nach oben

Current Diabetes Reports

Erschienen in:

01.07.2021 | Economics and Policy in Diabetes (AA Baig and N Laiteerapong, Section Editors)

Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes

verfasst von: Karishma A. Datye, Daniel R. Tilden, Angelee M. Parmar, Eveline R. Goethals, Sarah S. Jaser

Erschienen in: Current Diabetes Reports | Ausgabe 7/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

Continuous glucose monitors (CGM) are transforming diabetes management, yet adolescents and young adults (AYA) with type 1 diabetes (T1D) do not experience the same benefits seen with CGM use in adults. The purpose of this review is to explore advances, challenges, and the financial impact of CGM use in AYA with T1D.

Recent Findings

CGM studies in young adults highlight challenges and suggest unique barriers to CGM use in this population. Recent studies also demonstrate differences in CGM use related to race and ethnicity, raising questions about potential bias and emphasizing the importance of patient-provider communication. Cost of these devices remains a significant barrier, especially in countries without nationalized reimbursement of CGM.

Summary

More research is needed to understand and address the differences in CGM utilization and to increase the accessibility of CGM therapy given the significant potential benefits of CGM in this high-risk group.

Miller KM, Foster NC, Beck RW, Bergenstal RM, DuBose SN, DiMeglio LA, et al. Current state of type 1 diabetes treatment in the U.S.: updated data from the T1D Exchange clinic registry. Diabetes Care. 2015;38(6):971–8.PubMedCrossRef

•• Foster NC, Beck RW, Miller KM, Clements MA, Rickels MR, DiMeglio LA, et al. State of type 1 diabetes management and outcomes from the T1D Exchange in 2016-2018. Diabetes Technol Ther. 2019;21(2):66–72. Key study describing diabetes related outcomes in the large T1D Exchange Clinical Registry.PubMedPubMedCentralCrossRef

Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, et al. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med. 2008;359(14):1464–76.PubMedCrossRef

Charleer S, Mathieu C, Nobels F, De Block C, Radermecker RP, Hermans MP, et al. Effect of continuous glucose monitoring on glycemic control, acute admissions, and quality of life: a real-world study. J Clin Endocrinol Metab. 2018;103(3):1224–32.PubMedCrossRef

Marks BE, Wolfsdorf JI. Monitoring of pediatric type 1 diabetes. Front Endocrinol (Lausanne). 2020;11:128.CrossRef

Dorando E, Haak T, Pieper D. Continuous glucose monitoring for glycemic control in children and adolescents diagnosed with diabetes type 1: a systematic review and meta-analysis. Exp Clin Endocrinol Diabetes. 2020.

Garg SK, Akturk HK. A new era in continuous glucose monitoring: food and drug administration creates a new category of factory-calibrated nonadjunctive, interoperable class II medical devices. Diabetes Technol Ther. 2018;20(6):391–4.PubMedCrossRef

Medtronic. Innovation Milestones. 2021. Available from: https://www.medtronicdiabetes.com/about-medtronic-innovation/milestone-timeline . Accessed 12 March 2021.

FDA. FDA authorizes first fully Interoperable continuous glucose monitoring System, Streamlines REVIEW pathway for similar devices. 2018. Available from: https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-fully-interoperable-continuous-glucose-monitoring-system-streamlines-review. Accessed 12 March 2021.

10.

Abbott. FreeStyle Libre 2: Now Available in U.S. 2020. Available from: https://www.abbott.com/corpnewsroom/diabetes-care/freestyle-libre-2-now-available-in-us.html. Accessed 12 March 2021.

11.

FDA. MiniMed 770G System - P160017/S076. 2020. Available from: https://www.fda.gov/medical-devices/recently-approved-devices/minimed-770g-system-p160017s076. Accessed 12 March 2021.

12.

Edelman SV, Argento NB, Pettus J, Hirsch IB. Clinical implications of real-time and intermittently scanned continuous glucose monitoring. Diabetes Care. 2018;41(11):2265–74.PubMedCrossRef

13.

Abbott. Get Started Your Guide to the FreeStyle Libre 2 System. 2020. Available from: https://www.freestyle.abbott/content/dam/adc/fds/us-en/documents/get-started-guide.pdf. Accessed 12 March 2021.

14.

Welsh JB, Derdzinski M, Parker AS, Puhr S, Jimenez A, Walker T. Real-time sharing and following of continuous glucose monitoring data in youth. Diabetes Ther. 2019;10(2):751–5.PubMedPubMedCentralCrossRef

15.

Galindo RJ, Aleppo G. Continuous glucose monitoring: the achievement of 100 years of innovation in diabetes technology. Diabetes Res Clin Pract. 2020;170:108502.PubMedCrossRef

16.

Berget C, Messer LH, Vigers T, Frohnert BI, Pyle L, Wadwa RP, et al. Six months of hybrid closed loop in the real-world: an evaluation of children and young adults using the 670G system. Pediatr Diabetes. 2020;21(2):310–8.PubMedPubMedCentralCrossRef

17.

Lal RA, Basina M, Maahs DM, Hood K, Buckingham B, Wilson DM. One year clinical experience of the first commercial hybrid closed-loop system. Diabetes Care. 2019;42(12):2190–6.PubMedPubMedCentralCrossRef

18.

Pinsker JE, Müller L, Constantin A, Leas S, Manning M, McElwee Malloy M, et al. Real-world patient-reported outcomes and glycemic results with initiation of control-IQ technology. Diabetes Technol Ther. 2021;23(2):120–7.PubMedPubMedCentralCrossRef

19.

van Beers CA, DeVries JH, Kleijer SJ, Smits MM, Geelhoed-Duijvestijn PH, Kramer MH, et al. Continuous glucose monitoring for patients with type 1 diabetes and impaired awareness of hypoglycaemia (IN CONTROL): a randomised, open-label, crossover trial. Lancet Diabetes Endocrinol. 2016;4(11):893–902.PubMedCrossRef

20.

Charleer S, De Block C, Van Huffel L, Broos B, Fieuws S, Nobels F, et al. Quality of life and glucose control after 1 year of nationwide reimbursement of intermittently scanned continuous glucose monitoring in adults living with type 1 diabetes (FUTURE): a prospective observational real-world cohort study. Diabetes Care. 2020;43(2):389–97.PubMedCrossRef

21.

Beck RW, Riddlesworth T, Ruedy K, Ahmann A, Bergenstal R, Haller S, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: the DIAMOND randomized clinical trial. Jama. 2017;317(4):371–8.PubMedCrossRef

22.

Charleer S, Gillard P, Vandoorne E, Cammaerts K, Mathieu C, Casteels K. Intermittently scanned continuous glucose monitoring is associated with high satisfaction but increased HbA1c and weight in well-controlled youth with type 1 diabetes. Pediatr Diabetes. 2020;21(8):1465–74.PubMedCrossRef

23.

Sherr JL, Tauschmann M, Battelino T, de Bock M, Forlenza G, Roman R, et al. ISPAD clinical practice consensus guidelines 2018: diabetes technologies. Pediatr Diabetes. 2018;19(Suppl 27):302–25.PubMedCrossRef

24.

•• Laffel LM, Kanapka LG, Beck RW, Bergamo K, Clements MA, Criego A, et al. Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020;323(23):2388–96. Key study examining continuous glucose monitor use in AYA.

25.

Sheikh K, Bartz SK, Lyons SK, DeSalvo DJ. Diabetes device use and glycemic control among youth with type 1 diabetes: a single-center, cross-sectional study. J Diabetes Res. 2018;2018:5162162.PubMedPubMedCentralCrossRef

26.

Pickup JC, Ford Holloway M, Samsi K. Real-time continuous glucose monitoring in type 1 diabetes: a qualitative framework analysis of patient narratives. Diabetes Care. 2015;38(4):544–50.PubMedCrossRef

27.

Burckhardt MA, Abraham MB, Mountain J, Coenen D, Paniora J, Clapin H, et al. Improvement in psychosocial outcomes in children with type 1 diabetes and their parents following subsidy for continuous glucose monitoring. Diabetes Technol Ther. 2019;21(10):575–80.PubMedCrossRef

28.

Burckhardt MA, Roberts A, Smith GJ, Abraham MB, Davis EA, Jones TW. The use of continuous glucose monitoring with remote monitoring improves psychosocial measures in parents of children with type 1 diabetes: a randomized crossover trial. Diabetes Care. 2018;41(12):2641–3.PubMedCrossRef

29.

Vesco AT, Jedraszko AM, Garza KP, Weissberg-Benchell J. Continuous glucose monitoring associated with less diabetes-specific emotional distress and lower A1c among adolescents with type 1 diabetes. J Diabetes Sci Technol. 2018;12(4):792–9.PubMedPubMedCentralCrossRef

30.

Messer LH, Cook PF, Tanenbaum ML, Hanes S, Driscoll KA, Hood KK. CGM benefits and burdens: two brief measures of continuous glucose monitoring. J Diabetes Sci Technol. 2019;13(6):1135–41.PubMedPubMedCentralCrossRef

31.

Charleer S, De Block C, Nobels F, Radermecker RP, Lowyck I, Mullens A, et al. Sustained impact of real-time continuous glucose monitoring in adults with type 1 diabetes on insulin pump therapy: results after the 24-month RESCUE study. Diabetes Care. 2020;43(12):3016–23.PubMedCrossRef

32.

• Addala A, Maahs DM, Scheinker D, Chertow S, Leverenz B, Prahalad P. Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance. Pediatr Diabetes. 2020. This study highlights the importance of uninterrupted CGM use.

33.

Battelino T, Liabat S, Veeze HJ, Castañeda J, Arrieta A, Cohen O. Routine use of continuous glucose monitoring in 10 501 people with diabetes mellitus. Diabet Med. 2015;32(12):1568–74.PubMedPubMedCentralCrossRef

34.

Naranjo D, Tanenbaum ML, Iturralde E, Hood KK. Diabetes technology: uptake, outcomes, barriers, and the intersection with distress. J Diabetes Sci Technol. 2016;10(4):852–8.PubMedPubMedCentralCrossRef

35.

Lanning MS, Tanenbaum ML, Wong JJ, Hood KK. Barriers to continuous glucose monitoring in people with type 1 diabetes: clinician perspectives. Diabetes Spectr. 2020;33(4):324–30.PubMedCrossRef

36.

• Messer LH, Tanenbaum ML, Cook PF, Wong JJ, Hanes SJ, Driscoll KA, et al. Cost, Hassle, and On-body experience: barriers to diabetes device use in adolescents and potential intervention targets. Diabetes Technol Ther. 2020;22(10):760–7. Examines barriers to diabetes device use in adolescents.PubMedCrossRef

37.

Tanenbaum ML, Hanes SJ, Miller KM, Naranjo D, Bensen R, Hood KK. Diabetes device use in adults with type 1 diabetes: barriers to uptake and potential intervention targets. Diabetes Care. 2017;40(2):181–7.PubMedCrossRef

38.

Borus JS, Laffel L. Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention. Curr Opin Pediatr. 2010;22(4):405–11.PubMedPubMedCentralCrossRef

39.

Comeaux SJ, Jaser SS. Autonomy and insulin in adolescents with type 1 diabetes. Pediatr Diabetes. 2010;11(7):498–504.PubMedPubMedCentralCrossRef

40.

•• Agarwal S, Kanapka LG, Raymond JK, Walker A, Gerard-Gonzalez A, Kruger D, et al. Racial-ethnic inequity in young adults with type 1 diabetes. J Clin Endocrinol Metab. 2020;105(8):e2960–9. Key study describing racial inequity in T1D.PubMedCentralCrossRef

41.

•• Agarwal S, Schechter C, Gonzalez J, Long JA. Racial-ethnic disparities in diabetes technology use among young adults with type 1 diabetes. Diabetes Technol Ther. 2020. This study describes concering racial-ethnic disparities in diabetes technology use.

42.

Tanenbaum ML, Adams RN, Hanes SJ, Barley RC, Miller KM, Mulvaney SA, et al. Optimal use of diabetes devices: clinician perspectives on barriers and adherence to device use. J Diabetes Sci Technol. 2017;11(3):484–92.PubMedPubMedCentralCrossRef

43.

Cappon G, Vettoretti M, Sparacino G, Facchinetti A. Continuous glucose monitoring sensors for diabetes management: a review of technologies and applications. Diabetes Metab J. 2019;43(4):383–97.PubMedPubMedCentralCrossRef

44.

DeSalvo DJ, Miller KM, Hermann JM, Maahs DM, Hofer SE, Clements MA, et al. Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: International comparison from the T1D Exchange and DPV Initiative. Pediatr Diabetes. 2018;19(7):1271–5.PubMedPubMedCentralCrossRef

45.

Sumnik Z, Szypowska A, Iotova V, Bratina N, Cherubini V, Forsander G, et al. Persistent heterogeneity in diabetes technology reimbursement for children with type 1 diabetes: The SWEET perspective. Pediatr Diabetes. 2019;20(4):434–43.PubMedCrossRef

46.

Anderson JE, Gavin JR, Kruger DF. Current eligibility requirements for CGM coverage are harmful, costly, and unjustified. Diabetes Technol Ther. 2020;22(3):169–73.PubMedPubMedCentralCrossRef

47.

Anhalt H. Limitations of continuous glucose monitor usage. Diabetes Technol Ther. 2016;18(3):115–7.PubMedCrossRef

48.

Sonksen PH, Judd SL, Lowy C. Home monitoring of blood-glucose. Method for improving diabetic control. Lancet. 1978;1(8067):729–32.PubMedCrossRef

49.

van den Boom L, Karges B, Auzanneau M, Rami-Merhar B, Lilienthal E, von Sengbusch S, et al. Temporal trends and contemporary use of insulin pump therapy and glucose monitoring among children, adolescents, and adults with type 1 diabetes between 1995 and 2017. Diabetes Care. 2019;42(11):2050–6.PubMedCrossRef

50.

•• Wan W, Skandari MR, Minc A, Nathan AG, Winn A, Zarei P, et al. Cost-effectiveness of continuous glucose monitoring for adults with type 1 diabetes compared with self-monitoring of blood glucose: the DIAMOND randomized trial. Diabetes Care. 2018;41(6):1227–34. Demonstrates the cost-effectiveness of CGM devices.PubMedPubMedCentralCrossRef

51.

Roze S, Isitt JJ, Smith-Palmer J, Lynch P, Klinkenbijl B, Zammit G, et al. Long-term cost-effectiveness the Dexcom G6 real-time continuous glucose monitoring system compared with self-monitoring of blood glucose in people with type 1 diabetes in France. Diabetes Ther. 2021;12(1):235–46.PubMedCrossRef

52.

Garcia-Lorenzo B, Rivero-Santana A, Vallejo-Torres L, Castilla-Rodriguez I, Garcia-Perez S, Garcia-Perez L, et al. Cost-effectiveness analysis of real-time continuous monitoring glucose compared to self-monitoring of blood glucose for diabetes mellitus in Spain. J Eval Clin Pract. 2018;24(4):772–81.PubMedCrossRef

53.

Chaugule S, Oliver N, Klinkenbijl B, Graham C. An economic evaluation of continuous glucose monitoring for people with type 1 diabetes and impaired awareness of hypoglycaemia within North West London Clinical Commissioning Groups in England. Eur Endocrinol. 2017;13(2):81–5.PubMedPubMedCentralCrossRef

54.

Chaugule S, Graham C. Cost-effectiveness of G5 Mobile continuous glucose monitoring device compared to self-monitoring of blood glucose alone for people with type 1 diabetes from the Canadian societal perspective. J Med Econ. 2017;20(11):1128–35.PubMedCrossRef

55.

Nicolucci A, Rossi MC, D'Ostilio D, Delbaere A, de Portu S, Roze S. Cost-effectiveness of sensor-augmented pump therapy in two different patient populations with type 1 diabetes in Italy. Nutr Metab Cardiovasc Dis. 2018;28(7):707–15.PubMedCrossRef

56.

Roze S, Isitt J, Smith-Palmer J, Javanbakht M, Lynch P. Long-term cost-effectiveness of Dexcom g6 real-time continuous glucose monitoring versus self-monitoring of blood glucose in patients with type 1 diabetes in the U.K. Diabetes Care. 2020;43(10):2411–7.PubMedCrossRef

57.

Kraaijeveld SR. Continuous glucose monitoring as a matter of justice. HEC Forum. 2020.

Titel: Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes
verfasst von: Karishma A. Datye
Daniel R. Tilden
Angelee M. Parmar
Eveline R. Goethals
Sarah S. Jaser
Publikationsdatum: 01.07.2021
Verlag: Springer US
Erschienen in: Current Diabetes Reports / Ausgabe 7/2021
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI: https://doi.org/10.1007/s11892-021-01389-1

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

CAR-M-Zellen: Warten auf das große Fressen

22.05.2024 Onkologische Immuntherapie Nachrichten

Auch myeloide Immunzellen lassen sich mit chimären Antigenrezeptoren gegen Tumoren ausstatten. Solche CAR-Fresszell-Therapien werden jetzt für solide Tumoren entwickelt. Künftig soll dieser Prozess nicht mehr ex vivo, sondern per mRNA im Körper der Betroffenen erfolgen.

Frühzeitige HbA1c-Kontrolle macht sich lebenslang bemerkbar

22.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes von Anfang an intensiv BZ-senkend zu behandeln, wirkt sich positiv auf Komplikationen und Mortalität aus – und das offenbar lebenslang, wie eine weitere Nachfolgeuntersuchung der UKPD-Studie nahelegt.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen