Association Between Continuous Glucose Monitoring Utilization and Glucagon-Like Peptide-1 Receptor Agonist Discontinuation in Type 2 Diabetes: A Real-World Study

Introduction: Continuous glucose monitoring (CGM) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) when used jointly are associated with significant improvement in glycemic outcomes. However, it is unknown if using CGM enhances GLP-1 RA continuation. This study assesses the relationship between adherent CGM utilization and GLP-1 RA adherence among people living with type 2 diabetes (T2D) on nonintensive therapy. Methods: This retrospective matched-cohort study analyzed data from Inovalon ® Insights administrative claims from March 1, 2017, to April 30, 2024, for adults aged ≥18 years diagnosed with T2D, treated with basal insulin or noninsulin therapy, and CGM-naïve before starting GLP-1 RA. Adherent CGM utilization was defined as having a proportion of days covered (PDC) ≥0.8 within 1-year post GLP-1 RA initiation. CGM users were matched with non-CGM users based on age, sex, race/ethnicity, basal insulin/noninsulin therapy, GLP-1 RA type, comorbidities, insurance type, and one fill/multiple refills of GLP-1 RA. The primary outcome was GLP-1 RA discontinuation over the 12-month observation period, which was defined as the first gap of ≥90 days without GLP-1 RA supply post-index. Kaplan–Meier model was used to estimate the time to discontinuation, and hazard ratios (HRs) were calculated using a multivariable Cox proportional hazards regression model. Results: The study included 934 adherent CGM users matched with 3747 non-CGM users. One year post GLP-1 RA initiation, 68.4% (95% confidence interval [CI]: 65.5%–71.5%) of adherent CGM users remained on GLP-1 RA compared with 51.9% (95% CI: 50.3%–53.5%) of non-CGM users ( P < 0.001). After adjusting for covariates, adherent CGM users were significantly less likely to discontinue GLP-1 RA compared to non-CGM users (HR: 0.56 [95% CI: 0.49–0.63], P < 0.001). Conclusions: This study suggests that adherent CGM utilization is associated with a significantly lower risk of GLP-1 RA discontinuation and may potentially enhance adherence to GLP-1 RA medication in people living with T2D on nonintensive therapy.