Universal Subsidized Continuous Glucose Monitoring Funding for Young People With Type 1 Diabetes: Uptake and Outcomes Over 2 Years, a Population-Based Study

Objective: Continuous glucose monitoring (CGM) is increasingly used in type 1 diabetes management however funding models vary. This study determined the uptake rate and glycaemic outcomes following a change in national health policy to introduce universal subsidised CGM funding for people with type 1 diabetes aged < 21 years.

Research Design and Methods: Analysis of longitudinal data from 12 months prior to subsidy until 24 months after. Measures and outcomes included age, diabetes duration, HbA1c, episodes of diabetic ketoacidosis and severe hypoglycaemia, insulin regimen, CGM uptake and percentage CGM use. Two data sources were used: the Australasian Diabetes Database Network (ADDN) registry (a prospective diabetes database) and the National Diabetes Supply Scheme (NDSS) registry that includes almost all individuals with type 1 diabetes nationally.

Results: CGM uptake increased from 5% pre-subsidy to 79% after two years. After CGM introduction, the odds ratio (OR) of achieving the HbA1c target of <7.0% improved at 12 months (OR 2.5, p<0.001) and was maintained at 24 months (OR 2.3, p<0.001). The OR for suboptimal glycaemic control (HbA1c ≥ 9.0%) decreased to 0.34 (p<0.001) at 24 months. Of CGM users, 65% used CGM >75% of time: these had a lower HbA1c at 24 months compared to those with usage <25% (7.8±1.3% vs 8.6±1.8%, respectively, p<0.001). DKA was also reduced in this group (IRR 0.49, 95% CI 0.33-0.74, p<0.001).

Conclusions: Following national subsidy, CGM use was high and associated with sustained improvement in glycaemic control. This information will inform economic analyses and future policy and serve as a model of evaluation diabetes technologies.