2026/03/25 by Paul Dupenloup, Yupeng Chen, Priya Prahalad +7 · 1 voice
Biochemistry, Genetics and Molecular Biology · Medicine · #Diabetes Management and Research #Diabetes and associated disorders #Hyperglycemia and glycemic control in critically ill and hospitalized patients
paper · doi:10.2337/dc25-2825
openalex publication_date 2026/03/25 · openalex created_date 2026/03/26 · openalex updated_date 2026/07/31
OBJECTIVE: The use of continuous glucose monitoring (CGM) with remote patient monitoring (RPM) continues to grow. We evaluated the cost-effectiveness of CGM with RPM compared with self-monitoring of blood glucose (SMBG) and CGM alone. RESEARCH DESIGN AND METHODS: We simulated type 1 diabetes progression with a Markov model in 5-year-old patients over a 20-year, 50-year, and lifetime horizon. We tracked diabetic ketoacidosis (DKA), severe hypoglycemia (SH), and seven chronic complications: retinopathy, neuropathy, nephropathy, cardiovascular disease, end-stage renal disease, lower-extremity amputation, and blindness. We compared three interventions: SMBG, CGM, and CGM with RPM. Efficacy estimates were derived from meta-analyses of pediatric CGM studies and the results of the Teamwork, Targets, Technology, and Tight Glycemia Study (4T Study 1). We evaluated quality-adjusted life years (QALYs) and health care costs (2022 U.S. dollars) discounted at 3% annually. We performed extensive sensitivity analyses. RESULTS: Compared with SMBG, CGM increased QALYs by 0.09 and costs by 8,900 over 20 years; CGM with RPM increased QALYs by 0.37, and costs by 10,300. CGM with RPM yielded more QALYs at a lower incremental cost-effectiveness ratio compared with CGM (27,400/QALY vs. 103,700/QALY, respectively). Results were robust across sensitivity analyses and time horizons. CGM with RPM remained cost-effective when achieving at least 30% of 4T's clinical efficacy. CONCLUSIONS: CGM with RPM delivers superior health outcomes compared with SMBG and CGM and is likely cost-effective for patients with newly diagnosed type 1 diabetes. Despite higher intervention costs, CGM with RPM can reduce complications costs and generate net health care savings.