Continuous Glucose Monitoring and Hospitalization Outcomes in Adults with Insulin-Treated Type 2 Diabetes and Complex Care Needs: A Population-Based Study.

AIM: Continuous glucose monitoring (CGM) improves glycemic outcomes in insulin-treated type 2 diabetes (T2D), but evidence in individuals with complex care needs (CCN) is limited. We evaluated the association between CGM initiation and hospitalization outcomes in a population-based cohort of adults with insulin-treated T2D and CCN. METHODS: We conducted a population-based quasi-experimental study including all eligible adults with insulin-treated T2D and CCN who initiated CGM through the Andalusian Public Health System. Rates of acute diabetes-related complications and cardiovascular admissions were compared before and after CGM initiation using Poisson regression models adjusted for person-time. Interrupted time-series analyses, length of stay (LOS), and hospitalization costs were also evaluated. RESULTS: Of 17,561 adults initiating CGM, 5281 met criteria for CCN and were included (mean age 79 years; 55.1% aged ≥ 80 years). Acute diabetes-related hospitalization rates decreased from 144.27 to 41.04 per 10,000 person-years (rate ratio [RR] 0.28, 95% CI 0.19-0.42), and cardiovascular admission rates decreased from 387.25 to 251.96 per 10,000 person-years (RR 0.65, 95% CI 0.54-0.78). Interrupted time-series analyses showed post-intervention hospitalization rates consistently below counterfactual estimates. Mean LOS decreased by 3.68 days (95% CI -5.26 to -2.10; P < 0.001), and hospitalization costs decreased by USD657.39 per patient-year. CONCLUSION: In this population-based cohort of adults with insulin-treated T2D and CCN, CGM initiation was associated with fewer hospitalizations, shorter hospital stays, and lower hospitalization costs, supporting the integration of diabetes technology into chronic care strategies for highly vulnerable populations.