Disparities in Continuous Glucose Monitor Uptake Among Veterans With Diabetes Despite Universal Coverage

We commend Alkabbani et al. (1) for their important work highlighting differences in continuous glucose monitor (CGM) uptake among insulin-treated older adults with type 2 diabetes.The authors found that CGM use was low (<10%) and that disparities remained by race, ethnicity, and socioeconomic status (SES), with SES markedly increasing disparity.The Veterans Health Administration (VHA) is the largest integrated health care system in the U.S., providing care to 9.1 million veterans enrolled (2).Within the VHA CGMs are available for free to veterans who meet clinical criteria for use, which include diagnosis of type 1 or type 2 diabetes, daily insulin use, substantial hypoglycemia risk, pregnancy, work responsibilities where hypoglycemia poses harm, inability to perform finger-stick checks, and documented ability to use the CGM with 6-month follow-up.The criteria loosely mirror those for Medicare coverage, but U.S. Department of Veterans Affairs (VA) implementation is uniform nationwide.Disparities still exist despite this universal coverage.In a national study of >368,000 veterans with diabetes on insulin, investigators found that only 11.2% were prescribed a CGM (3).Odds of receiving a prescription were significantly lower for Black (adjusted odds ratio 0.62, 95% CI 0.59-0.64)and Hispanic (0.79, 0.74-0.84)veterans than for White and non-Hispanic veterans, even after adjustment for clinical and system variables.Disparities appear to be driven by prescriber practice, differential