Strengths of this study include specificity to the veteran population using VA resources, as well as including nondiabetes outcomes. This allows for specific application to the veteran population and could provide broader evidence for CGM use. Demonstrated decreases in HbA1c, weight, and clinic visits in the adherent population suggest that providing veterans with CGM therapy with frequent endocrinology follow-up improves health outcomes and could decrease overall health spending.
Limitations
Limitations of this study include retrospective design, a small sample size, and solely focusing on T2DM. As a retrospective study, we cannot rule out the influence of outside factors, such as participation in a non-VA weight loss program. This study lacked the power to assess the impact of the different CGM brands. The study did not include data on severe hypoglycemic or hyperglycemic episodes as veterans might have needed emergent care at non-VA facilities. Future research will evaluate the impact of CGM on symptomatic and severe hypoglycemic episodes and use of insulin vs oral or noninsulin antihyperglycemics and the comparative efficacy of different CGM brands among veterans.
Conclusions
CGM did not correspond with clinically significant reductions in HbA1c. However, veterans with increased health care engagement were likely to achieve clinically significant HbA1c improvements. Adherent patients also had more reduction in weight and hospital or clinic visits with CGM compared with the total population. These veterans’ increased involvement in their health care might have led to better dietary and exercise adherence, which would have decreased insulin dosing and contributed to weight loss.