Most Medicare beneficiaries with diabetes treated with insulin either do not receive a prescription for continuous blood glucose monitoring or do not use the technology correctly, according to a study published in Diabetes Technology and Therapeutics.
A study led by Gary Puckrein examined intensive insulin therapy (either through an insulin pump or multiple daily injections) among 1.3 million Medicare recipients with diabetes in 2018.
The researchers divided study participants into four groups: Adults who acquired real-time continuous glucose monitoring (CGM) equipment; adults who fully acquired blood glucose monitoring equipment; those who partially received blood glucose monitoring equipment; and those with no record of getting either CGM or blood glucose monitoring equipment. The researchers considered someone to be using insulin and monitoring correctly if they got at least eighty percent of their prescribed supplies.
According to the findings, about thirty-five percent of the study participants did not follow their prescribed blood glucose monitoring plan. They also found that about thirty-eight percent of the participants had no record of acquiring blood glucose monitoring or CGM supplies.
In addition, the researchers found that Blacks had the highest record of adults with no history of blood glucose monitoring or CGM acquisition. About forty-six percent of Black adults had no record of blood glucose monitoring or CGM acquisition compared with approximately thirty-seven percent of Hispanic and White patients. However, the researchers found a higher percentage of people using CGM in White adults (3.7%) compared to 1.6% of Black adults and 1.3 % of Hispanic adults.
The researchers also found that about forty-seven percent of the participants had two or more comorbidities. In addition, according to the study, more than fifty percent of black and Hispanic patients had two or more comorbidities, compared with about forty-six percent of White beneficiaries.
Furthermore, the researchers found that Black beneficiaries had a higher proportion of people with two comorbidities with no glucose monitoring record than White and Hispanic beneficiaries.
For those with no comorbidities, hospitalization did not vary across glucose monitoring and adherence groups. However, Black adults with multiple health issues had higher hospitalization rates and costs than their White counterparts, regardless of their glucose monitoring method or adherence.
“Medicare beneficiaries with insulin-treated diabetes would benefit from concerted efforts to increase glucose monitoring adherence; blood glucose monitoring or real-time CGM,” the researchers wrote. “While poor adherence is likely influenced by many factors, we do know that structured diabetes self-management education is a potent enabler of adherence. It is imperative that Medicare take immediate steps to eliminate barriers to beneficiary access to diabetes self-management education and support and medical nutrition therapy services.”