This year, there were two key updates to existing Healthcare Effectiveness Data and Information Set (HEDIS) measures. Revising and renaming the measure from the previously recognized “Hemoglobin A1c [HbA1c] Control for Patients With Diabetes” to “Glycemic Status Assessment for Patients With Diabetes,” the National Committee for Quality Assurance now promotes Glycemic Status Assessment to allow the use of either HbA1c or the glucose management indicator, which is calculated using CGM-measured mean glucose, as an option to meet clinical criteria.
This update follows the American Diabetes Association’s (ADA’s) 2024 Standards of Care in Diabetes, which was released in late 2023 and included support for making CGM more available to individuals with type 2 diabetes (T2D). The authors of the 2024 Standards of Care wrote that the “use of CGM is beneficial and recommended for individuals at high risk for hypoglycemia (Grade A Evidence), which recognizes the benefit of CGM in reducing hypoglycemic episodes.” The ADA further recommended “assessing glycemic status by HbA1c and/or appropriate CGM metrics at least two times a year and more frequently (e.g., every 3 months) for individuals not meeting treatment goals who have frequent or severe hypoglycemia or hyperglycemia, changing health status, or growth and development in youth.”
In May 2024, the American Journal of Managed Care (AJMC) promoted the importance of CGM technology, indicating that the advancements made over the past 2 decades has made the use of CGM more user friendly with smaller sensors, decreased challenges of calibration with fingerstick monitoring, and overall device operability. Despite this advocacy, as reported in the AJMC, CGM remains underutilized in primary care; most people with T2D are treated in primary care settings.
In March 2023, the Center for Medicare and Medicaid Services announced expanded coverage of CGM for Medicare beneficiaries using any insulin regimen or patients who are not on insulin, but who have a history of problematic hypoglycemia. This coverage approval was based on the growing body of evidence supporting the effectiveness of CGM in patients with T2D. Another landmark support for CGM happened in 2023, with the ADA, American Academy of Clinical Endocrinologists, and Endocrine Society updating their respective clinical practice guidelines for the use of CGM. The changes to these guidelines included recommending the increased utilization of CGM in patients with T2D and ensuring continued and broadened access to CGM technology.
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