Effectiveness of Continuous Glucose Monitoring on Glycemic and Metabolic Outcomes in Type 2 Diabetes: A Two-Year Real-World Analysis

Abstract

Background:

To evaluate whether sustained use of continuous glucose monitoring (CGM) is associated with long-term patterns in glycemic control, safety indicators, and health care utilization among adults with type 2 diabetes (T2D) in routine clinical care.

Method:

A two-year retrospective chart review was conducted at a tertiary care center in Saudi Arabia. Adults with T2D who initiated second-generation CGM (FreeStyle Libre 2) and maintained use for 24 months were included. Glycemic, metabolic, and clinical outcomes were assessed at baseline, 12 months (T12), and 24 months (T24).

Results:

Among 222 adults (mean age 48.7 years; 48.2% female), sustained CGM use was associated with improvements across multiple glycemic parameters. Glycated hemoglobin (HbA1c) declined from 8.2% at baseline to 7.8% at T24, accompanied by reductions in mean glucose, self-monitoring of blood glucose frequency, glycemia risk indices, and glucose variability. %TIR_70-180 increased, time spent in hyperglycemia decreased, and time below range remained low throughout follow-up. Directionally similar glycemic improvements were observed across subgroups, including individuals with obesity, those treated with oral agents only, and those receiving insulin-based regimens. Beyond glycemic outcomes, body weight decreased by approximately 2 kg over 24 months. Diabetes-related emergency department visits declined from five participants (2.3%) at T0 to two (0.9%) at T12 and one (0.5%) at T24.

Conclusions:

Two-year use of CGM in routine care was associated with favorable trends in glycemic control, glycemic stability, self-monitoring behavior, and health care utilization. Long-term CGM integration may be feasible and potentially beneficial across diverse T2D populations, although prospective studies are needed to clarify the causal effects.