Devices for continuous glucose monitoring (CGM) have been developed to optimize blood glucose control and liberate people with diabetes from finger-prick glucose measurements. Since 2016, the devices have been reimbursed in Germany for people with diabetes receiving insulin therapy, resulting in their increased use among people with type 1 diabetes (T1D) and type 2 diabetes (T2D). We investigated the prevalence of CGM use and its associated factors among German adults with diabetes in 2017 and 2021/2022.
Methods:
Participants aged 18 years or older with diagnosed diabetes were identified from two nationwide population-based telephone surveys in 2017 (n = 1396) and 2021/2022 (n = 1456). Prevalence and dynamics of CGM use were examined overall and stratified by sociodemographic and diabetes-related characteristics. Factors associated with CGM use were obtained from logistic regression models.
Results:
The overall prevalence of CGM use was 8.2% in 2017 and 16.6% in 2021/2022. An increase in CGM use was observed across all the subgroups except for those without antidiabetic medications. CGM use increased from 31.1% to 75.4% in adults with T1D, from 6.3% to 13.6% in adults with T2D, and from 14.6% to 36.7% in all insulin users. In both surveys, younger age, insulin use, T1D, and reporting hypoglycemia were associated with CGM use. In addition, in 2017, higher education level and absence of obesity were associated with CGM use, whereas in 2021/2022, participation in the diabetes self-management education program and higher self-assessed quality of diabetes care were associated with CGM use.
Conclusion:
Among adults with diabetes in Germany, CGM use increased about twofold within 5 years, irrespective of sociodemographic factors. Educational inequality in CGM use diminished over time. The higher self-rated quality of diabetes care associated with the recent use of CGM provides further evidence to support its use among all adults with diabetes in Germany.
Get full access to this article
View all access options for this article.
References
1.
PleusS, FreckmannG, SchauerS, et al.Self-monitoring of blood glucose as an integral part in the management of people with type 2 diabetes mellitus. Diabetes Ther, 2022; 13(5):829–846; doi: 10.1007/s13300-022-01254-8
2.
GoldsteinDE, LittleRR, LorenzRA, et al.Tests of glycemia in diabetes. Diabetes Care, 2004; 27(7):1761–1773; doi: 10.2337/diacare.27.7.1761
3.
WeinstockRS, AleppoG, BaileyTS, et al.The role of blood glucose monitoring in diabetes management. Arlington (VA): American Diabetes Association; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566165/
4.
MillerEM. Using continuous glucose monitoring in clinical practice. Clin Diabetes, 2020; 38(5):429–438; doi: 10.2337/cd20-0043
5.
LinR, BrownF, JamesS, et al.Continuous glucose monitoring: A review of the evidence in type 1 and 2 diabetes mellitus. Diabet Med, 2021; 38(5):e14528; doi: 10.1111/dme.14528
6.
EhrhardtN, Al ZaghalE. Continuous glucose monitoring as a behavior modification tool. Clin Diabetes, 2020; 38(2):126–131; doi: 10.2337/cd19-0037
7.
FriedmanJ, CoyneK, AleppoG, et al.Beyond A1C: Exploring continuous glucose monitoring metrics in managing diabetes. Endocr Connect, 2023; 12(7); doi: 10.1530/EC-23-0085
8.
TeoE, HassanN, TamW, et al.Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: A systematic review of randomised controlled trials and meta-analysis. Diabetologia, 2022; 65(4):604–619; doi: 10.1007/s00125-021-05648-4
9.
DicembriniI, CosentinoC, MonamiM, et al.Effects of real-time continuous glucose monitoring in type 1 diabetes: A meta-analysis of randomized controlled trials. Acta Diabetol, 2021; 58(4):401–410; doi: 10.1007/s00592-020-01589-3
10.
JancevM, VissersTACM, VisserenFLJ, et al.Continuous glucose monitoring in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetologia, 2024; 67(5):798–810; doi: 10.1007/s00125-024-06107-6
11.
AjjanRA, BattelinoT, CosX, et al.Continuous glucose monitoring for the routine care of type 2 diabetes mellitus. Nat Rev Endocrinol, 2024; 20(7):426–440; doi: 10.1038/s41574-024-00973-1
12.
KargesB, TittelS, BeyA, et al.Continuous glucose monitoring versus blood glucose monitoring for risk of severe hypoglycaemia and diabetic ketoacidosis in children, adolescents, and young adults with type 1 diabetes: A population-based study. Lancet Diabetes Endocrinol, 2023; 11(5):314–323; doi: 10.1016/S2213-8587(23)00061-X
13.
TauschmannM, HermannJM, FreibergC, et al.; DPV Initiative. Reduction in diabetic ketoacidosis and severe hypoglycemia in pediatric type 1 diabetes during the first year of continuous glucose monitoring: A multicenter analysis of 3,553 subjects from the DPV registry. Diabetes Care, 2020; 43(3):e40–e42; doi: 10.2337/dc19-1358
14.
RousselR, RivelineJP, VicautE, et al.Important drop in rate of acute diabetes complications in people with type 1 or type 2 diabetes after initiation of flash glucose monitoring in France: The RELIEF Study. Diabetes Care, 2021; 44(6):1368–1376; doi: 10.2337/DC20-1690
BellidoV, AguileraE, Cardona-HernandezR, et al.Expert recommendations for using time-in-range and other continuous glucose monitoring metrics to achieve patient-centered glycemic control in people with diabetes. J Diabetes Sci Technol, 2023; 17(5):1326–1336; doi: 10.1177/19322968221088601
17.
BattelinoT, AlexanderCM, AmielSA, et al.Continuous glucose monitoring and metrics for clinical trials: An international consensus statement. Lancet Diabetes Endocrinol, 2023; 11(1):42–57; doi: 10.1016/S2213-8587(22)00319-9
18.
ElSayedNA, AleppoG, ArodaVR, et al.7. Diabetes technology: Standards of care in diabetes—2023. Diabetes Care, 2023; 46,(Suppl 1):S111–S127; doi: 10.2337/dc23-S007
19.
PleusS, UlbrichS, ZschornackE, et al.Documentation of skin-related issues associated with continuous glucose monitoring use in the scientific literature. Diabetes Technol Ther, 2019; 21(10):538–545; doi: 10.1089/dia.2019.0171
20.
FerreiraROM, TrevisanT, PasqualottoE, et al.Continuous glucose monitoring systems in noninsulin-treated people with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Diabetes Technol Ther, 2024; 26(4):252–262; doi: 10.1089/dia.2023.0390
21.
HeidemannC, DuY, MauzE, et al.Healthcare and health situation of adults with type 2 diabetes in Germany: The study GEDA 2021/2022-Diabetes. J Health Monit, 2024; 9(2):e 12128; doi: 10.2564/6/12128
22.
ReitzleL, IhleP, HeidemannC, et al.[Algorithm for the classification of type 1 and type 2 diabetes mellitus for the analysis of routine data]. Gesundheitswesen, 2023; 85(S 02):S119–Ss126; doi: 10.1055/a-1791-0918
23.
Gemeinsamer Bundesausschusses. Beschluss des Gemeinsamen Bundesausschusses über eine Änderung der Richtlinie Methoden vertragsärztliche Versorgung: Kontinuierliche interstitielle Glukosemessung mit Real-Time-Messgeräten (rtCGM) zur Therapiesteuerung bei Patientinnen und Patienten mit insulinpflichtigem Diabetes mellitus. Available from: https://www.g-ba.de/downloads/39-261-2623/2016-06-16_MVV-RL_rtCGM_BAnz.pdf
KlupaT, CzupryniakL, DzidaG, et al.Expanding the role of continuous glucose monitoring in modern diabetes care beyond Type 1 disease. Diabetes Ther, 2023; 14(8):1241–1266; doi: 10.1007/s13300-023-01431-3
26.
MillerKM, HermannJ, FosterN, et al.; T1D Exchange and DPV Registries. Longitudinal changes in continuous glucose monitoring use among individuals with type 1 Diabetes: International comparison in the German and Austrian DPV and U.S. T1D exchange registries. Diabetes Care, 2020; 43(1):E1–E2; doi: 10.2337/dc19-1214
27.
GrammesJ, SchmidS, BozkurtL, et al.; DPV initiative. Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow-up (DPV) registry. Diabet Med, 2024; 41(3):e15261; doi: 10.1111/dme.15261
PaprottR, HeidemannC, StühmannLM, et al.First results from the study ‘Disease knowledge and information needs - Diabetes mellitus (2017)’. J Health Monit, 2018;(Suppl 3):22–60; doi: 10.1788/6/RKI-GBE-2018-064
30.
SmithM, Albanese-O’NeillA, MacieiraT, et al.Human factors associated with continuous glucose monitor use in patients with diabetes: A systematic review. Diabetes Technol Ther, 2019; 21(10):589–601; doi: 10.1089/dia.2019.0136
31.
BaileyR, DonthiS, MarktS, et al.Evaluating factors associated with continuous glucose monitoring utilization with the type 1 diabetes exchange registry. J Diabetes Sci Technol, 2023; 17(6):1580–1589; doi: 10.1177/19322968221091299
32.
DuY, BaumertJ, PaprottR, et al.Diabetes-related distress and associated factors among adults with diabetes in Germany: Results of the nationwide study “Disease knowledge and information needs – Diabetes mellitus 2017”. J Psychosom Res, 2023; 164:111073; doi: 10.1016/j.jpsychores.2022.111073
33.
HeidemannC, DuY, SchubertI, et al.Prevalence and temporal trend of known diabetes mellitus Results of the German Health Interview and Examination Survey for Adults (DEGS1). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz, 2013; 56(5–6):668–677; doi: 10.1007/s00103-012-1662-5
34.
HuhnF, LangeK, JördeningM, et al.Real-world use of continuous glucose monitoring systems among adolescents and young adults with type 1 diabetes: Reduced burden, but little interest in data analysis. J Diabetes Sci Technol, 2023; 17(4):943–950; doi: 10.1177/19322968221081216
35.
van MarkG, LanzingerS, BarionR, et al.Patient and disease characteristics of adult patients with type 1 diabetes in Germany: An analysis of the DPV and DIVE databases. Ther Adv Endocrinol Metab, 2019; 10:2042018819830867; doi: 10.1177/2042018819830867
36.
van den BoomL, AuzanneauM, WoelfleJ, et al.Use of continuous glucose monitoring in pump therapy sensor augmented pump or automated insulin delivery in different age groups (0.5 to <26 years) with type 1 diabetes from 2018 to 2021: Analysis of the German/Austrian/Swiss/Luxemburg DPV Registry. J Diabetes Sci Technol, 2024; 18(5):1122–1131; doi: 10.1177/19322968231156601
37.
AuzanneauM, RosenbauerJ, MaierW, et al.Heterogeneity of access to diabetes technology depending on area deprivation and demographics between 2016 and 2019 in Germany. J Diabetes Sci Technol, 2021; 15(5):1059–1068; doi: 10.1177/19322968211028608
38.
DeSalvoDJ, MillerKM, HermannJM, et al.; T1D Exchange and DPV Registries. Continuous glucose monitoring and glycemic control among youth with type 1 diabetes: International comparison from the T1D Exchange and DPV Initiative. Pediatr Diabetes, 2018; 19(7):1271–1275; doi: 10.1111/pedi.12711
39.
WelshJB, PsavkoS, ZhangX, et al.Comparisons of fifth-, sixth-, and seventh-generation continuous glucose monitoring systems. J Diabetes Sci Technol, 2024; 18(1):143–147; doi: 10.1177/19322968221099879
40.
BlondeL, UmpierrezGE, ReddySS, et al.American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a diabetes mellitus Comprehensive Care Plan-2022 update. Endocr Pract, 2022; 28(10):923–1049; doi: 10.1016/j.eprac.2022.08.002
41.
SeidelD, Boggio MesnilF, CarusoA. Reimbursement pathways for new diabetes technologies in Europe: Top-down versus bottom-up. J Diabetes Sci Technol, 2019; 13(1):118–122; doi: 10.1177/1932296818789175
42.
PitoccoD, LaurenziA, TomaselliL, et al.; Working group of Diabetes and Technology AMD-SID-SIEDP. Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology. Nutr Metab Cardiovasc Dis, 2022; 32(10):2392–2398; doi: 10.1016/j.numecd.2022.07.003
43.
KarterAJ, ParkerMM, MoffetHH, et al.Association of real-time continuous glucose monitoring with glycemic control and acute metabolic events among patients with insulin-treated diabetes. JAMA, 2021; 325(22):2273–2284; doi: 10.1001/jama.2021.6530
44.
SherrillCH, LeeS. Prevalence, characteristics, and health-related quality of life of continuous glucose monitoring use according to the Behavioral Risk Factor Surveillance System 2014-2020. J Manag Care Spec Pharm, 2023; 29(5):541–549; doi: 10.1855/3/jmcp.2023.29.5.541
45.
MayberryLS, GuyC, HendricksonCD, et al.Rates and correlates of uptake of continuous glucose monitors among adults with type 2 diabetes in primary care and endocrinology settings. J Gen Intern Med, 2023; 38(11):2546–2552; doi: 10.1007/s11606-023-08222-3
46.
PathakS, KearinK, KahkoskaAR, et al.Impact of expanding access to continuous glucose monitoring systems among insulin users with type 1 or type 2 diabetes. Diabetes Technol Ther, 2023; 25(3):169–177; doi: 10.1089/dia.2022.0418
47.
JohnsonSR, Holmes-WalkerDJ, CheeM, et al.; ADDN Study Group. Universal subsidized continuous glucose monitoring funding for young people with type 1 diabetes: Uptake and outcomes over 2 years, a population-based study. Diabetes Care, 2022; 45(2):391–397; doi: 10.2337/dc21-1666
48.
AleppoG, HirschIB, ParkinCG, et al.Coverage for continuous glucose monitoring for individuals with type 2 diabetes treated with nonintensive therapies: An evidence-based approach to policymaking. Diabetes Technol Ther, 2023; 25(10):741–751; doi: 10.1089/dia.2023.0268
49.
ThomasA, HaakT, TombekA, et al.Expert exchange on the use of continuous glucose monitoring (CGM) in diabetes management: A current review and a look into the future. Diabetol Stoffwechsel, 2023; 18(1):57–68; doi: 10.1055/a-1849-2137
50.
SeufertJ, DänschelI, GölzS, et al.Continuous glucose monitoring (CGM) in people with type 2 diabetes not on multiple daily injections (MDI): Review of current evidence and potential future positioning. Diabetol Stoffwechsel, 2024; doi: 10.1055/a-2305-9093
51.
American Diabetes Association Professional Practice C. Diabetes Technology: Standards of Care in Diabetes—2024. Diabetes Care, 2024; 47:S126–S144; doi: 10.2337/dc24-S007
52.
Prasad-ReddyL, GodinaA, ChettyA, et al.Use of continuous glucose monitoring in older adults: A review of benefits, challenges and future directions. touchREV Endocrinol, 2022; 18(2):116–121; doi: 10.1792/5/EE.2022.18.2.116
53.
ReddyN, VermaN, DunganK. Monitoring Technologies- Continuous Glucose Monitoring, Mobile Technology, Biomarkers of Glycemic Control. [Updated 2023 Jul 8]. In: FeingoldKR, AnawaltB, BlackmanMR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279046/
54.
SchienkiewitzA, KuhnertR, BlumeM, et al.Overweight and obesity among adults in Germany—Results from GEDA 2019/2020-EHIS. J Health Monit, 2022; 7(3):21–28; doi: 10.2564/6/10293
BergenstalRM, LayneJE, ZisserH, et al.Remote application and use of real-time continuous glucose monitoring by adults with type 2 diabetes in a virtual diabetes clinic. Diabetes Technol Ther, 2021; 23(2):128–132; doi: 10.1089/dia.2020.0396
57.
KieuA, KingJ, GovenderRD, et al.The benefits of utilizing continuous glucose monitoring of diabetes mellitus in primary care: A systematic review. J Diabetes Sci Technol, 2023; 17(3):762–774; doi: 10.1177/19322968211070855
58.
Díez-FernándezA, Rodríguez-HuertaMD, Mirón-GonzálezR, et al.Flash glucose monitoring and patient satisfaction: A meta-review of systematic reviews. Int J Environ Res Public Health, 2021; 18(6):1–13; doi: 10.3390/ijerph18063123
59.
YaronM, RoitmanE, Aharon-HananelG, et al.Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes. Diabetes Care, 2019; 42(7):1178–1184; doi: 10.2337/dc18-0166
60.
CharleerS, De BlockC, Van HuffelL, et al.Quality of life and glucose control after 1 year of nationwide reimbursement of intermittently scanned continuous glucose monitoring in adults living with type 1 diabetes (FUTURE): A prospective observational real-world cohort study. Diabetes Care, 2020; 43(2):389–397; doi: 10.2337/dc19-1610
61.
DeshmukhH, AdelekeK, WilmotEG, et al.Clinical features of type 1 diabetes in older adults and the impact of intermittently scanned continuous glucose monitoring: An Association of British Clinical Diabetologists (ABCD) study. Diabetes Obes Metab, 2024; 26(4):1333–1339; doi: 10.1111/dom.15434
62.
DeshmukhH, WilmotEG, GregoryR, et al.Effect of flash glucose monitoring on glycemic control, hypoglycemia, diabetes-related distress, and resource utilization in the Association of British Clinical Diabetologists (ABCD) nationwide audit. Diabetes Care, 2020; 43(9):2153–2160; doi: 10.2337/dc20-0738
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
