Continuous Glucose Monitoring Initiation Is Associated With Reduced Mortality in Older-Onset Type 1 Diabetes Patients: A Target Trial Emulation Study Within the Veterans Health Administration
Authors' conclusion
In this large TTE of CGM initiation in older T1D patients, CGM use was associated with reduced risk for all-cause mortality.
Study context
- Population
- Adult T1D patients with second endocrine visit (time zero) in 2017–2020, Veterans Health Administration8,423 cloned to both strategies
- Participants
- 1,039 vs 7,399
- Exposure
- Continuous glucose monitoring (CGM) initiation vs no CGM
- CGMn = 1,039
- Non-CGMn = 7,399reference
- Outcome
- All-cause mortality
- Follow-up
- 1-4 years
Methodological detailsobservational health records, clone-censor-weight design, inverse probability weights, 6-month grace period, negative control outcomes
- Observational health records
- Clone-censor-weight design
- Inverse probability weights
- 6-month grace period
- Negative control outcomes
Main finding
As reported in the abstract
CGM vs Non-CGMAdjusted relative risk (95% CI)
Lower bound of range over follow-up
0.90(0.71–0.97)
Upper bound of range over follow-up
0.84(0.72–0.97)
Observational data: associations, not effects.
Further findings
Mortality with different grace periods (3 or 9 months)
- Similar risk ratios were seen with different grace periods
Mortality by subgroup
- Age >65 years or not on insulin pumps appeared to have greater benefit
- Effects did not vary by HbA1c, race or ethnicity, or frailty
Incident nondiabetes (negative control) outcomes
- Risk ratios did not differ between groups, incl. outpatient or inpatient musculoskeletal or gastrointestinal conditions
Original publication
Continuous Glucose Monitoring Initiation Is Associated With Reduced Mortality in Older-Onset Type 1 Diabetes Patients: A Target Trial Emulation Study Within the Veterans Health Administration. Diabetes Care. Published 19 June 2026. doi:10.
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