Continuous glucose monitors (CGMs) have been associated with improved quality of life, improved glycemic control, and decreased acute care use among type 2 diabetic populations. However, their uptake historically remained limited and largely concentrated in patients with type 1 diabetes, which is mainly due to earlier clinical guidelines restrictions. According to recent updates in 2021, recommendations support the use of CGM utilization in older adults who are taking multiple daily insulin injections.
Subsequently, Medicare expanded CGM coverage in 2023 to include both non-insulin and insulin users; however, the real-world impact of these guidelines and policy changes on CGM uptake remains unclear. A recent study published in the Journal of Managed Care & Specialty Pharmacy aimed to evaluate the trends in use of CGM among Medicare Advantage (MA) beneficiaries with type 2 diabetes between 2021 and 2023. This study also compares the clinical features and demographic characteristics of CGM users and non-CGM users during 2023.
In this repeated cross-sectional, retrospective study, pharmacy and medical claims data were collected from the Humana Healthcare Research Database, which includes the data related to prescriptions, demographics, and clinical information. MA beneficiaries with type 2 diabetes receiving insulin were detected annually from 2021 (n = 222,236), 2022 (n = 229,093), and 2023 (n = 286,951). Patients without insulin use, with incomplete claims access, and with both type 2 and type 1 diabetes were excluded. CGM use was identified via durable medical equipment claims. Clinical characteristics (Diabetes Complications Severity Index [DCSI] and Deyo–Charlson Comorbidity Index [CCI] scores), outpatient utilization (including endocrinology and primary care visits), and demographic characteristics were analyzed using 2023 data. Descriptive and logistic regression analyses were performed.
Monthly CGM use increased from 1.4% in January 2021 to 17.2% in December 2023, with annual averages of 4.8% (2021), 10.2% (2022), and 13.7% (2023). In 2023, 49,395 (17%) were CGM users, and 237,556 (83%) were non-users. CGM users were mostly younger (67.2±9.35 vs 69.3±9.04 years), more often female (56% vs 53.9%), White (67% vs 60.6%), and disabled (51.2% vs 44.4%), as well as more likely to reside in the Midwest region (24.3% vs 19.1%).
Clinically, CGM users had a higher CCI score (4.09±2.38 vs 3.79±2.46) and greater DCSI score (3.09±2.24 vs 2.65±2.16) compared to non-users with standardized mean difference (SMD) = 0.123 and SMD = 0.196, respectively. They also had higher healthcare utilization, including more endocrinology visits (39.5% vs 12.5%, SMD = 0.648) and primary care visits (96.2% vs 93.3%, p = 0.128), as well as a mean number of endocrinology visits compared to non-users (1.03 vs 0.28, SMD = 0.13).
Logistic regression analysis showed increased odds of CGM use with rurality (odds ratio [OR] = 1.19, 95% confidence interval [CI]: 1.16-1.22), female (OR = 1.10, 95% CI: 1.07-1.12), disability (OR = 1.03, 95% CI: 1.01-1.06), retinopathy (OR = 1.32, 95% CI: 1.29-1.35), Midwest region (OR = 1.35, 95% CI: 1.31-1.38), endocrinology (OR = 4.35, 95% CI: 4.25-4.45), metabolic complications (OR = 1.38, 95% CI: 1.33-1.43), and neuropathy (OR = 1.45, 95% CI: 1.41-1.48) whereas age ≥85 years (OR = 0.44, 95% CI: 0.41-0.48) and Black race (OR = 0.78, 95% CI: 0.76-0.80) were associated with lower use of CGM.
This study has several limitations, including its descriptive design, potential confounding from concurrent increases in glucose-lowering treatments, assessment of CGM prevalence without evaluating long-term or persistent use, and lack of outcome measures linking CGM use to clinical benefits.
In conclusion, this study highlights that CGM use increased from 2021 to 2023 after Medicare expansion. However, its use remained lower among cognitively-impaired, older, and less-engaged type 2 diabetic patients. Addressing disparities may improve the accessibility and education of diabetes management decisions.
Reference: Boudreau E, Rastegar J, Swankoski K, Hames A, Mugavin M, Ross JS. Trends in use of continuous glucose monitors among individuals with type 2 diabetes enrolled in Medicare Advantage (2021-2023). J Manag Care Spec Pharm. 2026;32(3):329-335. doi:10.18553/jmcp.2026.32.3.329
