Overall uptake and racial, ethnic, and socioeconomic disparities in the use of continuous glucose monitoring devices among insulin-treated older adults with type 2 diabetes.

Objective: To assess time trends of and examine which sociodemographic and clinical characteristics are associated with continuous glucose monitoring (CGM) initiation in insulin-treated older adults with type-2 diabetes (T2D). Research design and methods: Using data from Medicare fee-for-service (2013-2020) and Optum’s de-identified Clinformatics® Data Mart Database (Clinformatics®) (2013-2022), we identified patients aged ≥65 years with T2D receiving insulin therapy who initiated CGM annually. Initiation of a CGM device was defined based on Current Procedural Terminology codes and National Drug Codes. Then, we 1:4 matched new users of CGM to patients unexposed to CGM, using risk set sampling. Index date was the date of CGM initiation or, for controls, the closest physician visit within +/-7 days. We used logistic regression to assess demographic and clinical characteristics associated with CGM initiation. Results: The annual CGM initiation rate rose from 107 to 5,249/100,000 in Medicare (2013–2020) and from 796 to 9,195/100,000 in Clinformatics® (2013–2022). Compared to White patients, Hispanic (OR, 95% CI 0.44, 0.42-0.48 in Medicare and 0.81, 0.78-0.85 in Clinformatics®) and Black (OR, 95% CI 0.71, 0.69-0.73 in Medicare and 0.89, 0.85-0.92 in Clinformatics®) individuals were less likely to receive CGM. Older age and residing in low socioeconomic status areas were associated with lower CGM uptake, while history of hypoglycemia and lower frailty scores increased CGM initiation likelihood. Conclusions: CGM initiation has increased over time but remains <10% among insulin-treated older adults with T2D. Substantial racial, ethnic, and socioeconomic disparities were observed.