Real-time CGM significantly improves HbA1c and time in range in poorly controlled type 2 diabetes
Key takeaway:
A 6-month RCT in 172 adults with poorly controlled type 2 diabetes found that the Glunovo real-time CGM system significantly reduced HbA1c by 1.4% compared to 0.6% with standard glucometer monitoring, and increased time in range from 70% to 89%.
Study at a glance
Study type
RCTs
duration
Medium-Term (3–12 mo)
Intervention
Continuous glucose monitoring
Outcomes
HbA1c, Time in range, Time above range, Time below range, Fasting Plasma Glucose, Quality of life, Treatment satisfaction
Funding
Non-industry sponsored
What was studied
Glunovo rtCGM vs SMBG for glycemic control in T2D
What they found
- ↓ HbA1c reduced by 1.4% with rtCGM vs 0.6% with SMBG (p<0.001)
- ↑ Time in range improved from 70% to 89% with rtCGM (Δ=+18.4%, p<0.001)
- ↓ Time above range decreased from 25% to 9.3% with rtCGM (p<0.001)
mainEffects
↓ HbA1c reduced by 1.4% with rtCGM vs 0.6% with SMBG (p<0.001)
↑ Time in range improved from 70% to 89% with rtCGM (Δ=+18.4%, p<0.001)
↓ Time above range decreased from 25% to 9.3% with rtCGM (p<0.001)
Evidence Suggest
- Glunovo rtCGM significantly improves glycemic control in poorly controlled T2D compared to standard SMBG
- Patient satisfaction with rtCGM was high and improved substantially over the study period
- Overall well-being (WHO-5) showed no significant improvement despite better glycemic control
Who this applies to
Adults with poorly controlled type 2 diabetes (HbA1c 7.5-11%) on various treatment regimens including basal-bolus insulin, basal-oral therapy, or noninsulin agents. Results are most relevant to patients who are not using CGM technology and have suboptimal glycemic control.
Keep in Mind
The study was open-label, so patients knew they were using CGM, which may have influenced behavioral changes and satisfaction scores. The SMBG group did not have CGM data available for TIR/TAR/TBR comparison. Some patients discontinued due to technical issues with the new device. The WHO-5 well-being index may not be sensitive enough to capture diabetes-specific quality of life changes.
Between the Lines
- Open-label design may introduce bias, particularly for patient-reported satisfaction outcomes
- SMBG group lacked CGM-derived metrics (TIR, TAR, TBR) for direct between-group comparison
- 7 participants (8.1%) in the rtCGM group discontinued due to device-related issues
- Single-center study in Italy may limit generalizability to other populations and healthcare settings
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Sources
International Consensus on Time in Range: Clinical Targets for Continuous Glucose Monitoring Data Interpretation
ADA/EASD Consensus Report: The Management of Type 1 Diabetes in Adults
Abaloparatide Followed by Alendronate Shows Promising Results for Women With Osteoporosis, T2D | American Association of Clinical Endocrinology
Connecting the Dots: Diabetes, CKD, and CVD Pathways | American Association of Clinical Endocrinology
Episode 39: AACE 2023 Updated Comprehensive Type 2 Diabetes Management Algorithm | American Association of Clinical Endocrinology
Linagliptin Does Not Increase Adverse Renal Events in Patients With T2D, Kidney Disease | American Association of Clinical Endocrinology
Non-Insulin Injectable Therapies for Diabetes Management | American Association of Clinical Endocrinology
WHO-5 Well-Being Index: A Systematic Review of the Literature
A Prospective Study of the Correlation Between Time in Range and Incidence of Diabetic Cardiovascular Autonomic Neuropathy in Patients with Type 2 Diabetes Mellitus.
Using Nutrition to Improve Time in rangE (UNITE): A Randomized Clinical Trial with Continuous Glucose Monitoring in People with Type 2 Diabetes Not Taking Insulin.
Quality-Score (Q-Score) Can Be More Sensitive than %Time in Range and Several Other CGM Metrics in Detecting Responses to Therapeutic Interventions.
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