Daily Dose: Flash CGM Improves Glycemic Control in Patients with T2D Using Noninsulin Therapies

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On June 13, 2023, we reported on a study published in Diabetes, Obesity and Metabolism that examined the efficacy and patient satisfaction of intermittently scanned continuous glucose monitoring (isCGM) in adults using noninsulin therapies for the management of type 2 diabetes (T2D).

The study

The study was conducted at 6 Canadian diabetes specialty centers with recruitment and screening running from September 8, 2020, to December 24, 2021. Eligibility required T2D duration of ≥6 months, baseline HbA1c ≥7.5%, treatment with at least 1 noninsulin antihyperglycemic agent, and no prior experience with CGM. Researchers randomized participants in a 1:1 ratio to isCGM+DSME or to DSME alone. CGM devices were blinded. All participants attended identical educational visits with a CDE and completed the Glucose Measurement Satisfaction Survey (GMSS), the Diabetes Distress Scale, and several other behavioral measures.

The primary outcome was the difference in percentage mean target glycemic range (TIR) (glucose 70-180 mg/dL) measured using blinded CGM recording during the final 2 weeks of the 16-week study period between the intervention and control groups. Among several secondary outcomes of interest were mean HbA1c, time spent below range (TBR; <70 mg/dL), target range (TAR) (>180 mg/dL), and device satisfaction via the GMSS.

The final cohort of 116 participants had a mean age of 58 years, T2D duration of 10 years, mean baseline HbA1c of 8.6%, and 36.2% were women. At study enrollment, participants were using an average of 2.6 noninsulin therapies.

The findings

When assessed at 16 weeks, mean TIR was significantly greater among participants in the isCGM+DSME arm by 9.9% (2.4 hours) (95% CI, −17.3% to −2.5%; P<.01) and TAR was significantly lower by 8.1% (1.9 hours) (95% CI, 0.5% to 15.7%; P =.037) vs the DSME-only group.

Researchers noted there was improvement in HbA1c in both groups with isCGM at 7.6% (from 8.5% at baseline) and DSME at 8.1% (from 8.7%) at 16 weeks. This translated into a greater mean reduction in the isGGM+DSME group of 0.3% (95% CI, 0% to 0.7%; P = .048) vs the DSME-only group.

Reports of hypoglycemia were low in both groups as was TBR, with no significant difference between the groups, according to the study. Neither group reported increase in diabetes distress. Glucose monitoring satisfaction was higher among isCGM users (adjusted difference −0.5 [95% CI, −0.7 to −0.3], P < .01).

Clinical implications

"The IMMEDIATE RCT, among non-insulin–treated individualswith type 2 diabetes, suggests a benefit in both CGM outcomes andin HbA1c with the use of isCGM and targeted DSME."

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