Impact of Type 1 Diabetes and Severe Hypoglycemia on Productivity and Out-of-Pocket Costs of Adult Continuous Glucose Monitor Users: Results From a Cross-Sectional Survey in the United States

OBJECTIVES: T1D is an incurable, life-limiting disease. Dependence on exogenous insulin for glycemic control has several challenges, including impaired awareness of hypoglycemia (IAH) and severe hypoglycemic events (SHE). There is limited understanding of the impact these serious and acute conditions have on productivity and out-of-pocket (OOP) costs of adult continuous glucose monitor (CGM) users. This research aims to describe this impact.

METHODS: Adult CGM users (aged ≥18 years) from the T1D Exchange Registry completed an online survey, including measures of work and life productivity (Diabetes Productivity Measure; score 0–100; higher score = greater productivity). Cohorts were created based on SHE frequency in the past 12 months and the presence/absence of IAH (IAH+: modified Gold score ≥4): problematic SHE (2+ SHE/IAH-; 1+ SHE/IAH+), single SHE/no IAH (1 SHE/IAH-), undetermined IAH (≥0 SHE and modified Gold score = 3), and no SHE (0 SHE/IAH+; 0 SHE/IAH-). Work productivity was calculated for employed participants. Descriptive analyses (mean [standard deviation (SD)] and frequencies) of characteristics and patient-reported productivity outcomes are reported overall and by SHE cohort.

RESULTS: Participants (N=1,847) had a mean age of 45.9 years, and most were female (67.5%) and employed (68.5%). Among them, 375 met criteria for a cohort of problematic SHE (20.3%); 102 for single SHE/no IAH (5.5%); 337 for undetermined IAH (18.2%); and 1,033 for no SHE (55.9%). The problematic SHE cohort reported the lowest levels of productivity, whereas the no SHE cohort reported the highest levels of productivity (life productivity: 59.0 vs. 72.3; work productivity: 75.6 vs. 85.9). Mean (SD) annual OOP costs associated with T1D care were $3,112 ($8,242) and $2,416 ($2,616) for the problematic SHE and no SHE cohorts, respectively.

CONCLUSIONS: Despite advanced diabetes technology use, productivity impairment and substantial OOP costs were observed in adults continuing to experience severe hypoglycemia, suggesting greater unmet need in this patient population.