Introduction and Objective: Chronic kidney disease (CKD), driven in large part by hyperglycemia, remains a major complication of T1D. Yet, evidence on whether initiation of CGM may slow renal disease progression is limited. As observational studies are susceptible to various biases, we used target trial emulation (TTE) to examine the effects of CGM vs. no CGM treatment strategies on renal outcomes in T1D. Methods: VHA T1D patients who were enrolled at their 2nd endocrinology visit (time 0, n=8246) during 2017-2020. Their EHR data were replicated for both CGM initiation and non-initiation strategies and a subsequent 6-month grace period used to identify CGM initiators. Inverse probability weighting was used to account for predictors of CGM initiation and censoring due to deviation from assigned treatment. A composite of progression to end-stage renal disease (ESRD), defined by stage 5 CKD or sustained eGFR 15, was the outcome. Risk ratios (RRs) were estimated over 4 years. Results: Median age and baseline eGFR at baseline were 57 and 87 ml/min. CGM initiation was associated with a lower risk of progression to stage 5 CKD/ESRD compared with non-initiation (Table). Similar protective associations were also observed for an eGFR decline ≥30%. Conclusion: Using a robust TTE framework, CGM initiation in adult T1D was associated with reduced progression to rapid eGFR decline and development of ESRD. Disclosure S. Macwan: None. P. Reaven: Research Support; Current; Dexcom, Inc., Lilly Global Health Partnership. J. Zhou: None. D.R. Miller: None. Funding Jin Zhou: NIDDK (R01 DK142026; NSF DMS 2054253;IIS 2205441), Peter Reaven : VA Merit (I01BX006126)
MACWAN et al. (Fri,) studied this question.
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