Continuous glucose monitoring in type 2 diabetes mellitus

Abstract

The use of continuous glucose monitoring (CGM) in people with type 2 diabetes (T2D) is expanding, with clear evidence of benefit in individuals with T2D who use basal insulin.

In the Mobile clinical trial, CGM use was associated with a 0.4% reduction in HbA1c¹. This data is confirmed in real-world studies showing reductions of 1.1% and 1.4% at 3 or 6 months of follow-up, respectively².] Furthermore, the use of CGM in T2D reduced hospitalizations for ketoacidosis by 75% and for severe hypoglycemia by 45% after one year of use³.

At the 2024 Advanced Technologies & Treatments for Diabetes (ATTD) Congress, a real-world study was presented that included 1,781 people with T2D being treated with GLP-1 receptor agonists. CGM use was associated with a reduction in HbA1c by 1.5% (from 9.8% at baseline to 8.3% at 6 months, p < 0.001)⁴. In another study, the simultaneous initiation of a GLP-1 agonist and a CGM system reduced HbA1c more than the addition of the GLP-1 agonist alone (-2.41 vs -2.06, p < 0.001)⁵.

Additionally, CGM is a great educational tool. A study conducted in Korea evaluated a nutritional education program associated with flash glucose monitoring or blood glucose monitoring, which used a very simple algorithm to help people make decisions about their diet based on glucose levels. Participants in the flash monitoring group had a greater reduction in fasting glucose (-16.5 mg/dL, P = 0.017), body weight (-1.5 kg, P = 0.013), HbA1c (-0.50%, P < 0.001), and better scores in the self-care questionnaire after the intervention⁶.

In summary, the evidence of the benefit of CGM in T2D is growing and is no longer limited to insulin users. Benefits also include its use as an educational tool to improve diet, enhance the benefits of GLP-1 agonists, and allow comprehensive evaluation of the impact of different therapies to optimize metabolic control.