1903-P: Continuous Glucose Monitoring with Prandial Insulin Use among Medicare Patients with Type 2 Diabetes Mellitus and Reductions in Diabetic Ketoacidosis Events

Introduction and Objective: Diabetic ketoacidosis (DKA) is a serious complication of diabetes. A recent study reported fewer DKA events after continuous glucose monitoring (CGM) initiation in the French population with type 1 diabetes (T1D). In the U.S., prior studies show reductions in acute diabetic events, but data on DKA are limited. This study examined the association between CGM use and changes in frequency of DKA events in the Medicare fee-for-service (FFS) population with type 2 diabetes (T2D). Methods: We analyzed 100% CMS FFS Parts A, B, and D data from 2018-2022. Patients on prandial insulin with ICD-10 codes for T2D were identified from ≥1 inpatient or ≥2 outpatient claims; those with T1D or gestational diabetes, ESRD, or age 65 were excluded. The earliest CGM claim defined the index date with requirement of 1 year of continuous coverage before and after. Counts of DKA events and patients with ≥1 event were captured. A mixed-effects, zero-inflated negative binomial regression adjusted for comorbidities, depression, retinopathy, neuropathy, age, gender, race/ethnicity, CGM index year, and dual eligibility estimated DKA rates. Results: Among 78,813 patients, 51.7% were female; 84.4% White, 6.8% Black, 2.3% Asian, 2.0% Hispanic, 4.6% other; 23.8% had depression, 27.3% retinopathy, 86.9% lipid disorder, 51.6% neuropathy. Mean (SD) age was 74.2 (6.5) years; Charleston Comorbidity Index score was 5.6 (2.9). Before CGM, 1,241 (1.6%) had ≥1 DKA event vs. 586 (0.7%) after (p0.001). Adjusted IRR is 0.85 (95% CI 0.73-0.99). Conclusion: CGM use in Medicare FFS patients on prandial insulin for T2D was associated with significant DKA reductions. Incorporating CGM into diabetes management for older adults may lessen acute events and healthcare burden. Disclosure C. Wysham: Advisory Panel; Current; Abbott Diabetes. Speaker's Bureau; Current; Abbott Diabetes. Research Support; Ended; AbbVie Inc., Bayer AG, Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk. Advisory Panel; Current; Eli Lilly and Company. Research Support; Ended; Eli Lilly and Company. Speaker's Bureau; Current; Eli Lilly and Company. Stock/Shareholder; Current; Pendulum. Speaker's Bureau; Ended; MannKind Corporation. E.M. Miller: Advisory Panel; Current; Abbott. Speaker's Bureau; Current; Bayer AG, Corcept Therapeutics, Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi. E. Donckels: None. S. Mehta: Employee; Current; Abbott Diabetes. A. Lee: Employee; Current; Abbott Diabetes. Funding Abbott Diabetes Care