Continuous Glucose Monitors and Reduced Diabetes-Related Hospitalizations in Patients with Type 2 Diabetes and Chronic Kidney Disease.

BACKGROUND:There is a heightened risk of glycemic variability in patients with diabetes and chronic kidney disease (CKD). This glycemic variability could lead to hypoglycemic or hyperglycemic crises. We hypothesized that initiation of continuous glucose monitoring (CGM), which provides a glucose measurement every 1-5 minutes, could reduce the incidence of hospitalizations for patients with type 2 diabetes (T2D) and CKD. METHODS:A retrospective analysis of US administrative claims data from the Optum Clinformatics© Database was conducted. People with T2D, using insulin, not receiving dialysis, and living with stage 3-5 CKD who initiated CGM between 1/1/2016 and 3/31/2022 were identified. NDC and HCPCS codes were used to identify CGM device use and ICD-10 codes were used to identify CKD diagnosis and categorize healthcare encounters. Rates of diabetes-related hospitalizations were obtained, and multivariable logistic regression analyses revealed predictors of hypoglycemic and hyperglycemic encounters. RESULTS:A total of 8,959insulin-using patients with T2D and CKD were identified. Most were White (72.3%), had Medicare insurance coverage (82.2%), were using intensive insulin (91.3%), and had Stage 3 CKD (86.0%). After CGM initiation, rates of hospitalizations for hyperglycemia or hypoglycemia decreased by 18.2% and 17.0%, respectively (p<0.0001 for both). The proportion hospitalized with at least one hypoglycemic or hyperglycemic event also significantly decreased after CGM initiation. Significant predictors of both hypoglycemic and hyperglycemic encounters included a previous encounter of that type, age 30-59 years and depression (for hypoglycemia), and age 30-49 and neuropathy (for hyperglycemia). Use of CGM or glucagon-like peptide-1 receptor agonists was significantly protective against hypoglycemic encounters. CONCLUSIONS:Initiation of CGM was associated with significant reductions in diabetes-related hospitalizations among insulin-using individuals with T2D and moderate-to-severe CKD. CGM could help patients with T2D and CKD control their glucose and avoid potentially dangerous glycemic events.