973-P: Initiation of Dexcom CGM Is Associated with Improved Renal Outcomes in Adults with Chronic Kidney Disease (CKD) on Insulin Therapy

Introduction and Objective: A recent consensus statement advocated for wider use of CGM in people with CKD and emphasized the need for additional research. This study evaluated the impact of initiating Dexcom CGM on the progression of CKD in adults using insulin. Methods: A retrospective analysis using Truveta-provided de-identified EMR data was conducted. We identified insulin-using adults with T1D or T2D with eGFR of 15-89 mL/min/1.73m2 who initiated Dexcom G-series CGM between 08/01/2018 and 12/31/2023 (index date=first CGM claim). The control group included CGM non-users, assigned an index date based on their first outpatient encounter with an eGFR. Exclusion criteria included cirrhosis, pregnancy, prior CGM use, anemia, dialysis, renal transplant, and Elixhauser score ≥10. CKD progression was defined as an increase in CKD stage. Change in eGFR was assessed as the difference between baseline eGFR (within 12 months of index date) and 3 years. Multivariate linear regression estimated the association between the initiation of Dexcom CGM and change in eGFR. Covariates included demographics, baseline eGFR and A1c, diabetes type, history of hypertension or micro/macrovascular complications, and use of SGLT2, GLP-1 RA or RAASi therapy. Results: A total of 65,839 adults with CKD on insulin therapy were identified (633 Dexcom CGM users; 65,206 CGM non-users). At 3 years, 24.8% of Dexcom CGM users experienced CKD progression vs. 34.8% of CGM non-users (p<0.01). Among CGM non-users, the 3 year change in eGFR was -8.58 mL/min/1.73m². After adjustments, initiating Dexcom CGM was associated with an improvement of 1.21 mL/min/1.73m2, which is a 14% reduction in the rate of progression (p<0.05). Conclusion: Our findings show that using Dexcom CGM is associated with a significant reduction in kidney disease progression among adults with CKD using insulin. This evidence supports the recent consensus statement supporting CGM use in individuals with CKD. Disclosure K. Hannah: Employee; Dexcom, Inc. C. Chen: Employee; Dexcom, Inc. M. Tressler: Employee; Dexcom, Inc. J. Castle: Employee; Dexcom, Inc. Stock/Shareholder; Dexcom, Inc. G.J. Norman: Employee; Dexcom, Inc.