Trends in use of continuous glucose monitors among individuals with type 2 diabetes enrolled in Medicare Advantage (2021-2023).

Abstract

In 2023, the Centers for Medicare and Medicaid Services (CMS) expanded continuous glucose monitoring (CGM) coverage in Medicare among individuals with type 2 diabetes and insulin use; however, little is known about current trends in CGM use among Medicare beneficiaries with type 2 diabetes. To assess trends in CGM use among Medicare beneficiaries with type 2 diabetes from 2021 to 2023 and to compare demographic and clinical characteristics of beneficiaries who used CGMs to those who did not in 2023. This was a retrospective, repeated cross-sectional analysis. Using data from a large national Medicare Advantage (MA) plan, we described CGM use among MA beneficiaries with type 2 diabetes and evidence of insulin use to assess monthly trends in use from 2021 to 2023 and, using only 2023 data, examined characteristics of beneficiaries using CGMs. We found that the prevalence of CGM use among MA beneficiaries with type 2 diabetes and insulin use increased from 1.4% in January 2021 to 17.2% in December 2023. Among the 2023 cohort, CGM users compared with nonusers had more primary care physician (PCP) visits and a higher likelihood of having a visit with an endocrinologist. CGM users were more clinically complex (ie, exhibiting higher clinical risk scores using the Deyo-Charlson Comorbidity Index and the Diabetes Complications Severity Index), more likely to have visits with both PCPs and endocrinologists, and more likely to be younger, be White, be with a disability, and live in rural areas. CGM utilization in an MA population increased concurrent with the expanded clinical guideline changes and Medicare coverage, though certain types of beneficiaries were more likely to use CGMs than others in 2023. Awareness of the differences in uptake of CGMs among beneficiaries could aid future education and outreach opportunities.