Publications by authors named "Gregory Norman"

Objective: To examine the real-world impact of continuous glucose monitoring (CGM) use on glycemic management and health care resource utilization (HCRU) in people with diabetes in a large US-insured population.

Methods: This retrospective observational study used Aetna administrative claims data from a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and with coverage for medical and pharmacy benefits. The index date was the first CGM pharmacy or medical claim observed between January 1, 2019, and December 31, 2021.

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Objective: Management of advanced type 2 diabetes (T2D) typically involves daily insulin therapy alongside frequent blood glucose monitoring, as treatments such as oral antidiabetic agents are therapeutically insufficient. Real-time continuous glucose monitoring (rt-CGM) has been shown to facilitate greater reductions in glycated hemoglobin (HbA1c) levels and improvements in patient satisfaction relative to self-monitoring of blood glucose (SMBG). This study aimed to investigate the cost-utility of rt-CGM versus SMBG in Spanish patients with insulin-treated T2D.

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Aims: In 2022, the Centers for Medicare & Medicaid Services released proposed changes to Medicare's continuous glucose monitoring (CGM) coverage policy, making individuals with a history of problematic hypoglycaemia eligible for CGM coverage, irrespective of insulin use. This study estimated the burden of hypoglycaemia in Medicare Advantage beneficiaries with noninsulin-treated type 2 diabetes (T2D).

Materials And Methods: We retrospectively analysed US healthcare claims data using Optum's deidentified Clinformatics® database.

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Background: Discontinuity between health care delivery systems and community-based organizations is a significant barrier to improving population health.

Objective: To describe the facilitators and barriers experienced by a health system-community partnership 15 months after implementation.

Methods: Coalition members who led committees within the coalition or had active, sustained participation in coalition activities were invited to participate.

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Article Synopsis
  • This study assessed the cost-effectiveness of real-time continuous glucose monitoring (rt-CGM) compared to self-monitoring of blood glucose (SMBG) for people with type 2 diabetes in South Korea.
  • Using a model and real-world data, the researchers found rt-CGM increased quality-adjusted life years (QALYs) by 0.683 but also led to higher costs of KRW 16.4 million.
  • The incremental cost-utility ratio for rt-CGM was KRW 24.0 million per QALY gained, showing it is a cost-effective option compared to the willingness-to-pay threshold of KRW 46 million.
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Article Synopsis
  • * The research evaluated how quickly patients started using CGM after receiving it, showing an average delay of 3 weeks that lessened over time, and confirmed consistent daily wear time of over 22 hours.
  • * Findings revealed a strong agreement between CGM usage reported in EHRs and actual device data, demonstrating reliable integration and similar CGM usage patterns across different age and racial groups for both diabetes types.
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Introduction: Some people with type 2 diabetes (T2D) require intensive insulin therapy to manage their diabetes. This can increase the risk of diabetes-related hospitalizations. We hypothesize that initiation of real-time continuous glucose monitoring (RT-CGM), which continuously measures a user's glucose values and provides threshold- and trend-based alerts, will reduce diabetes-related emergency department (ED) and inpatient hospitalizations and concomitant costs.

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Key Points: Patients with diabetes and CKD have a heightened risk of glycemic variability, which can lead to severe hypoglycemic or hyperglycemic events, potentially resulting in hospitalization. This study describes the results of a retrospective claims analysis of people with insulin-requiring type 2 diabetes and stage 3–5 CKD who initiated continuous glucose monitoring. Continuous glucose monitoring could help patients with type 2 diabetes and CKD control their glucose and avoid potentially dangerous glycemic events.

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Clinical trials and real-world data for Type II diabetes both show that glycated hemoglobin (HbA1c) levels and hypoglycemia occurrence can be reduced by real-time continuous glucose monitoring (rt-CGM) versus self-monitoring of blood glucose (SMBG). The present cost-utility study investigated the long-term health economic outcomes associated with using rt-CGM versus SMBG in people with insulin-treated Type II diabetes in France. Effectiveness data were obtained from a real-world study, which showed rt-CGM reduced HbA1c by 0.

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Article Synopsis
  • Continuous glucose monitoring (CGM) improves glycemic outcomes for diabetes patients, but adherence levels and their impact on outcomes are not fully understood.
  • A study analyzed data from 7,669 individuals with type 1 or type 2 diabetes who started using either intermittent scanned (isCGM) or real-time CGM (rtCGM) over 12 months.
  • Results showed that rtCGM users had significantly higher adherence rates and better A1C reductions compared to isCGM users, indicating that commitment to CGM usage is crucial for managing blood sugar levels effectively.
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Clinical trials and real-world data for Type 2 diabetes have shown that real-time continuous glucose monitoring (rt-CGM) lowers glycated hemoglobin (A1c) and reduces hypoglycemia relative to self-monitoring of blood glucose (SMBG). This analysis examined the long-term health and economic outcomes associated with using rt-CGM versus SMBG in people with insulin-treated Type 2 diabetes in Canada. Clinical data were sourced from a real-world study, in which rt-CGM reduced A1C by 0.

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This retrospective analysis examined the association between change in A1C and professional continuous glucose monitoring (p-CGM) use in patients with type 2 diabetes and poor glycemic control who were not using insulin. Data from 15,481 eligible patients (p-CGM users = 707 and p-CGM nonusers = 14,774) showed a greater decrease in A1C from baseline to the end of follow-up for p-CGM users, and differences favored p-CGM users regardless of whether they started insulin therapy during the follow-up period. These findings suggest that people with type 2 diabetes who have poor glycemic control using multiple noninsulin therapies may benefit from p-CGM, which can reduce A1C over a 6-month period compared with usual care.

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Background: We used real-world electronic health record (EHR) data to examine HbA1c levels among children and adults with type 1 diabetes (T1D) who are classified as continuous glucose monitor (CGM) users after T1D diagnosis and switch to self-monitoring of blood glucose (SMBG) during follow-up, versus people who opt for SMBG after T1D diagnosis and switch to CGM during follow-up visits.

Methods: We conducted an observational, case-crossover study using electronic medical record (EMR) data from the T1D Exchange Quality Improvement Collaborative. The primary outcome in this study was HbA1c.

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Aims: Current continuous glucose monitoring (CGM) devices provide features that alert individuals with diabetes about their current and impending adverse glycaemic events. The use of these features has been associated with glycaemic improvements. However, how these features are utilised under real-world conditions has not been well studied.

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Article Synopsis
  • The study aimed to evaluate the advantages of continuous glucose monitoring (CGM) for adults with type 1 and type 2 diabetes, focusing on long-term glucose control and emergency healthcare events.
  • Researchers conducted a retrospective observational study within the Veterans Affairs Health Care System, comparing CGM users to nonusers over 12 months.
  • Results showed significant improvements in glucose control (lower HbA1c levels) for CGM users and reduced risks of hospital admissions related to blood sugar issues in both types of diabetes.
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Background: Physical inactivity is associated with numerous health risks, including cancer, cardiovascular disease, type 2 diabetes, increased health care expenditure, and preventable, premature deaths. The majority of Americans fall short of clinical guideline goals (ie, 8000-10,000 steps per day). Behavior prediction algorithms could enable efficacious interventions to promote physical activity by facilitating delivery of nudges at appropriate times.

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Background: The benefits of real-time continuous glucose monitoring (RT-CGM) are well established for patients with type 1 diabetes (T1D) and patients with insulin-treated type 2 diabetes (T2D). However, the usage and effectiveness of RT-CGM in the context of non-insulin-treated T2D has not been well studied.

Objective: We aimed to assess glycemic metrics and rates of RT-CGM feature utilization in users with T1D and non-insulin-treated T2D.

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We investigated the potential associations between race/ethnicity and adherence to prescribed glucose monitoring in a sample of Medicare beneficiaries with diabetes and how adherence to the method used impacted diabetes-related inpatient hospitalizations and associated costs among beneficiaries with intensive insulin-treated diabetes. This 12-month retrospective analysis utilized Centers for Medicare & Medicaid Services data to identify Medicare beneficiaries who used intensive insulin therapy from January through December 2018 and classified them into four groups: (1) persons using real-time continuous glucose monitoring (rtCGM), (2) persons using any method of blood glucose monitoring (BGM) who followed prescribed use patterns (adherent), (3) persons who were prescribed BGM but were nonadherent in its use, and (4) no record of any form of BGM. Analyses compared these groups and the role that comorbidities (Charlson Comorbidity Index [CCI]), and race/ethnicity played on group assignment, diabetes-related inpatient hospitalizations, and costs.

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Introduction: Real-time continuous glucose monitoring (rt-CGM) involves the measurement and display of glucose concentrations, potentially improving glucose control among insulin-treated patients with type 2 diabetes (T2D). The present analysis aimed to conduct a cost-effectiveness analysis of rt-CGM versus self-monitoring of blood glucose (SMBG) based on a USA retrospective cohort study in insulin-treated people with T2D adapted to the UK.

Methods: Long-term costs and clinical outcomes were estimated using the CORE Diabetes Model, with clinical input data sourced from a retrospective cohort study.

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Real-time continuous glucose monitoring (rtCGM) and intermittently scanned CGM (isCGM) have both been shown to improve glycaemic outcomes in people with T1D. The aim of this study was to compare real-world glycaemic outcomes at 6-12 months in a propensity score matched cohort of CGM naïve adults with T1D who initiated a rtCGM or an isCGM. Among the matched rtCGM and isCGM cohorts (n = 143/cohort), rtCGM users had a significantly greater HbA benefit compared to isCGM users (adjusted difference, -3 mmol/mol [95% CI, -5 to -1]; -0.

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Little is known about the impact of real-time continuous glucose monitoring (rtCGM) on diabetes-related medical costs within the type 2 diabetes (T2D) population. A retrospective analysis of administrative claims data from the Optum Research Database was conducted. Changes in diabetes-related health care resource utilization costs were expressed as per-patient-per-month (PPPM) costs.

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Introduction: Trauma-related guilt is common, associated with posttraumatic mental health problems, and can persist after posttraumatic stress disorder (PTSD) treatment. We compared the efficacy of two six-session psychotherapies, Trauma-Informed Guilt Reduction (TrIGR) and Supportive Care Therapy (SCT), for reducing trauma-related guilt. TrIGR helps patients accurately appraise their role in the trauma and re-engage in values.

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Article Synopsis
  • * Integrated exposure therapy (I-PE) and integrated coping skills therapy (I-CS) were compared, with I-PE generally yielding better outcomes in PTSD reduction and heavy drinking days, especially for those with Low PTSD/High AUD Impairment.
  • * The research highlights the importance of recognizing these symptom-based subgroups to better predict treatment responses and improve future interventions for veterans with comorbid PTSD and AUD.
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Background: Caregiving is a demanding role that can negatively impact a person's health and well-being. As such, adequate access to health care is important for maintaining the family caregiver's own personal health. The aims of this study were to identify if family caregivers of older adults had more difficulty accessing health care services than non-caregivers and to identify if family caregivers felt access to additional services would be beneficial for maintaining their own personal health care.

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