Impact of Real-Time Continuous Glucose Monitoring on Medication Use and Glycemic Control in Type 2 Diabetes Across Therapy Regimens

Purpose: This study evaluated how real-time continuous glucose monitoring (RT-CGM) use was associated with medication use patterns and A1c changes among people with type 2 diabetes (T2D) using non-insulin therapy (NIT), basal insulin therapy (BIT), or intensive insulin therapy (IIT). We hypothesized that RT-CGM use would be associated with more frequent medication class changes and reduction in polypharmacy, alongside greater improvements in A1c compared to CGM non-use. Patients and Methods: This retrospective study analyzed US administrative claims data from the Optum Clinformatics Data Mart database between 09/01/2016 and 06/30/2024. People with T2D were divided into NIT, BIT, or IIT cohorts. Each cohort contained two groups: Dexcom RT-CGM users or CGM non-users and 1:1 propensity score matching was performed to minimize differences between the groups. We compared changes in medication use and A1c levels between RT-CGM users and CGM non-users over 12 months. Results: Over 1.6 million people with T2D were identified prior to matching and stratified by therapy regimen as T2D-NIT, -BIT, or - IIT. After propensity score matching, the proportion of RT-CGM users taking ≥4 medications declined significantly and RT-CGM users had more net changes in their medications than CGM non-users. In addition, greater improvements in A1c were observed among RT-CGM users compared to CGM non-users in all cohorts (difference-in-differences of −0.4%, −0.5%, and −0.4% for T2D-NIT, T2D-BIT, and T2D-IIT, respectively, all p<0.0001). More RT-CGM users also achieved a mean A1c <7.0% or <8.0% at follow-up overall and among those not meeting the target at baseline. Conclusion: Higher rates of medication changes were associated with RT-CGM use. RT-CGM use was associated with significantly and meaningfully improved A1c levels among all T2D cohorts. The findings indicate that RT-CGM use could help all people with T2D improve their glycemia.