What does this research mean for the field?

Geriatric-tailored remote continuous glucose monitoring (CGM) education for older adults on insulin is highly cost-effective, projecting reduced 10-year complication risks and increased quality-adjusted life years with minimal added cost. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the cost-effectiveness and health outcomes of remote continuous glucose monitoring education for older adults with diabetes on insulin.

June 7, 2026

1018-OR: Cost-Effectiveness of Age-Specific Remote Education to Initiate and Sustain Use of CGM in Older Adults with Diabetes on Insulin

Key Points

This research aims to evaluate the cost-effectiveness and health outcomes of remote continuous glucose monitoring education for older adults with diabetes on insulin.
Projected 10-year clinical outcomes and costs using a discrete-time diabetes microsimulation model.
Enrolled adults ≥65 years on insulin, comparing REST-informed education to usual care.
Evaluated A1c improvements and associated diabetes/CVD complications over a simulated follow-up of 7.5 years.
For type 1 diabetes (T1D), reductions in major adverse cardiovascular events (MACE) by 2.54% and mortality by 2.85%.
For type 2 diabetes (T2D), reductions included stroke by 2.52% and mortality by 2.17%.
Cost per QALY was estimated at $14,493 for T1D and $26,775 for T2D with minimal added costs.

Abstract

Introduction and Objective: Older adults on insulin have high risk of diabetes and cardiovascular (CVD) complications, yet the health economic value of geriatric-tailored continuous glucose monitoring (CGM) education is poorly characterized. We projected 10-year clinical outcomes, costs, and quality-adjusted life years (QALY) associated with REST study-informed A1c improvement. Methods: The REST study enrolled adults ≥65 years on insulin (type 1 (T1D) or type 2 diabetes (T2D) ) and either CGM naive or CGM users not meeting glycemic targets (TIR 40% and/or hypoglycemia 4%). The intervention combined remote CGM education with geriatric principles, including individualized glycemic goals and insulin regimen simplification based on CGM patterns. We used the CDC/RTI discrete-time diabetes microsimulation model (risk-equation-based projections of complications, costs, and QALYs), using the data from REST, and compared a REST-informed scenario vs usual care by applying an adjusted mean A1c reduction of 0. 49% over 6 months. Simulations were run separately for T1D and T2D. Ten-year outcomes included total medical costs, QALYs, mortality, and diabetes/CVD complications. Results: Over 10 years (mean modeled follow-up 7. 5 years), the model projected lower complication risk and mortality in REST vs. usual care. For T1D, projected reductions included MACE −2. 54%, ESRD −6. 53%, proliferative diabetic retinopathy −17. 4%, amputation −12. 8%, and mortality −2. 85%. For T2D, projected reductions included stroke −2. 52%, MI −2. 76%, revascularization −2. 83%, dialysis −5. 01%, and mortality −2. 17%. QALYs increased by +0. 075 in T1D and +0. 040 in T2D, with small increases in modeled medical costs (+87 and +71). With a 1, 000 program cost assumption, implied cost per QALY was 14, 493 for T1D and 26, 775 for T2D. Conclusion: REST-informed projections indicate lower diabetes/CVD complications and better quality-adjusted survival over 10 years, with minimal added cost, supporting this scalable remote education for older adults on insulin. Disclosure A. Adam: None. S. Neuwahl: Other - Working on a project for this client as part of my normal duties as a health economist at my employer (RTI international). ; Current; Eli Lilly and Company, Sanofi. C. Slyne: None. M. Savory: None. N. Krakoff: None. J. Bulger: None. H. Brabant: None. Z. Tayebali: None. R. Weinstock: Research Support; Current; Amgen Inc. , Eli Lilly and Company, JDRF, Diasome, DEKA Research and Development, Tandem Diabetes Care, Inc. Research Support; Ended; Kowa Research Institute, Inc. Research Support; Current; National Institutes of Health. Research Support; Ended; Insulet Corporation. Research Support; Current; T1D Exchange. M. Munshi: Advisory Panel; Current; Abbott Diabetes. Research Support; Ended; Dexcom, Inc. E. Toschi: Consultant; Current; Vertex Pharmaceuticals Incorporated. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. Funding Funded provided by The Leona M. and Harry B. Helmsley Charitable Trust

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