“Experience Is Simply the Name We Give to Our Mistakes”: A New Opportunity to Improve Outcomes in Type 2 Diabetes

In a randomized clinical trial recently published in the Journal of Diabetes Science and Technology, Ehrhardt et al ¹ showed that in Latino people with type 2 diabetes (T2D) primarily not treated with insulin, a virtually delivered, culturally tailored education program combined with the use of continuous glucose monitoring (CGM) significantly improved glycated hemoglobin levels.

There is a wealth of literature on the benefits that education offers people with T2D in terms of glycemic control, reduction in hypoglycemia and complications risks, and improvement in quality of life.^2,3 Traditionally, diabetes education has been based on a unidirectional pathway, with information flowing from healthcare providers to patients. In contrast, the potential for people with diabetes to educate themselves has been largely underestimated.

The use of CGM systems is now a standard of care in type 1 diabetes, while the usefulness of CGM in insulin-treated individuals with T2D is increasingly recognized. ⁴ At the recent conference on Advanced Technologies and Treatments for Diabetes, the use of CGM in people with T2D who are being treated with non-insulin therapies was the focus of interest. Our quiver against T2D now includes new pharmaceutical options, such as sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and tirzepatide, which are associated with a low risk of hypoglycemia and reduced glycemic variability ⁵ : therefore, one could skeptically conclude that CGMs in non-insulin-treated T2D are unnecessary and the new trend is simply a pursuit of the voracious industry to create new consumer needs.

In fact, this approach overlooks a key element in the management of a lifelong condition that highly relies on the daily decisions made by people living with diabetes: the need for patients to learn from their mistakes. Preliminary evidence suggests that CGMs, even when used intermittently, such as for a few weeks throughout the year, enable people with T2D, particularly older adults, to better understand the impact of their dietary choices, exercise, and pharmacotherapy on glucose levels. This in turn enhances their ability to use real-time glycemic data for optimal self-management of diabetes. Furthermore, Gilbert et al ⁶ showed that the use of CGM is associated with significant improvements in psychosocial outcomes among individuals with T2D. Given current knowledge gaps, future studies should elucidate both the cost-effectiveness of CGM use and its impact on hard outcomes, such as cardiorenal events, in people with T2D treated with non-insulin therapies.

In conclusion, it is time to explore a new pathway to managing T2D that we may have underestimated to date: the ability of patients to self-educate. In this direction, CGMs and other technologies, such as artificial intelligence and mobile phone applications, can play an important role. As Oscar Wilde once wrote, “Experience is simply the name we give to our mistakes.” So why not give people with T2D this opportunity?