Association of Dexcom Continuous Glucose Monitor (CGM) Initiation with Improved Kidney Function in Adults with Diabetes and CKD on Insulin Therapy

Background: A 2025 consensus report by Rhee, et al. 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 (estimated by creatinine-based CKD-EPI formula) 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 evaluated as the change in eGFR (eGFR model) and albuminuria (AU model); assessed as the difference between baseline value (within 12 months of index date) and 3 years. Propensity score matching (1:1) balanced demographics, medication use and clinical characteristics. Multivariate linear regression estimated the association between the initiation of Dexcom CGM and change in eGFR/albuminuria. Covariates included demographics, baseline eGFR, A1c, and albuminuria [AU model only], diabetes type, history of hypertension or micro/macrovascular complications, and use of SGLT2, GLP-1 RA or RAASi therapy. Results: In the eGFR model, each matched cohort included 518 individuals. After adjusting for covariates, initiating Dexcom CGM was associated with a slower decline in eGFR of 1.74 mL/min/1.73m2, a 19.6% reduction in the rate of progression (p<0.05). Matching for the AU model included 138 CGM non-users and 138 Dexcom CGM users. After adjusting for covariates, the reduction in albuminuria was not statistically significant between Dexcom CGM users and CGM non-users (-38.06 mg/g, p=0.36). Conclusion: Our findings show that using Dexcom CGM was associated with a clinically significant reduction in kidney disease progression among adults with diabetes and CKD using insulin. This evidence aligns with the recent consensus statement supporting CGM use in individuals with CKD. Funding: Commercial Support - Dexcom Inc.