Outcomes of funded CGM access in young people with type 1 diabetes in Australia

In 2017 the Australian Government began fully funding continuous glucose monitoring (CGM) for people aged <21 years with type 1 diabetes. Eligibility criteria included all those aged <10 years, as well as those aged 10–21 years with more than one episode of severe hypoglycaemia per year, impaired hypoglycaemia awareness or ability to communicate hypoglycaemia, or significant fear of hypoglycaemia. This study sought to assess the uptake of funded CGM and its clinical outcomes.

Uptake of CGM increased from <5% prior to funding, to 79% by December 2019. The effects on HbA_1c were significant, with the proportion of people achieving an HbA_1c <53 mmol/mol (7.0%) more than doubling at 12 months (odds ratio [OR], 2.49) and 24 months (OR, 2.30) after CGM initiation. Conversely, the proportion of people with suboptimal HbA_1c <75 mmol/mol (9.0%) fell by two thirds at 12 months (OR, 0.31) and 24 months (OR, 0.34).

Absolute rates of severe hypoglycaemia fell from 10.7 to 6.8 events per 100 person-years at 24 months after CGM start (OR for a severe event, 0.59). No significant reduction in diabetic ketoacidosis (DKA) rates was identified post-CGM initiation; however, baseline event rates were low. Moreover, comparison between individuals showed that DKA rates were reduced in those who used CGM >75% of the time compared with those using it <25% of the time (incidence rate ratio, 0.49).

The authors conclude that universal funding of CGM results in rapid uptake and sustained use in the majority of people, as well as improvements in glycaemic control and clinical outcomes.

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