Improved Glycemic Control in Insulin-Treated Individuals With Poorly Controlled Type 2 Diabetes Through Combined Structured Education With Real-Time Continuous Glucose Monitoring

Abstract

Background:

We evaluated the efficacy of structured individualized education combined with real-time continuous glucose monitoring (rt-CGM, Dexcom G6) in improving glycemic outcomes in insulin-treated adults with poorly controlled type 2 diabetes (T2D).

Methods:

This multicenter, 16-week, single-arm study included 66 adults with T2D (multiple daily insulin [MDI]: 33; basal insulin: 33) with a ≥7.8%. Each cohort comprised 15 participants aged ≥60 years. The participants attended four educational sessions. The primary outcome was a change in glycated hemoglobin (HbA_1c) levels between baseline and week 16.

Results:

Sixty-four individuals were included in this study, with a mean age of 58.3 ± 12.4 years. The mean HbA_1c levels decreased from 9.0% at baseline to 7.1% at 16 weeks in the MDI group (difference: −1.8%, 95% confidence interval [CI] = −2.3 to −1.3) and from 8.8% to 7.0% in the basal insulin group (difference: −1.8%, 95% CI = −2.1 to −1.4). In the total population, the mean time in range 70 to 180 mg/dL increased by 25.2% (6 hours 4 minutes, 95% CI = 20.6 to 29.8), whereas the time in tight range 70 to 140 mg/dL increased by 17.3% (4 hours 10 minutes, 95% CI = 14.0 to 20.7). Both groups maintained a target of <1% of the time below the range of <54 mg/dL. Improvements in HbA_1c and CGM metrics were comparable between individuals aged ≥60 years and those aged <60 years (all P-values for interaction >.1).

Conclusions:

In adults with poorly controlled insulin-treated T2D, rt-CGM use with structured education significantly improved the HbA_1c and CGM metrics, primarily by reducing hyperglycemia, regardless of age.