Minimizing Glucose Excursions (GEM) With Continuous Glucose Monitoring in Type 2 Diabetes: A Randomized Clinical Trial

Abstract

This study aimed to compare conventional medication management of type 2 diabetes (T2D) to medication management in conjunction with a lifestyle intervention using continuous glucose monitoring to minimize glucose excursions. Thirty adults (63% female; mean age, 53.3 years) who were diagnosed with T2D for less than 11 years (mean, 5.6 years), had glycated A_1c (HbA_1c) ≥ 7.0% (51 mmol/mol) (mean 8.8%, [73 mmol/mol]), and were not using insulin, were randomly assigned in a 1:2 ratio to routine care (RC) or 4 group sessions of glycemic excursion minimization plus real-time CGM (GEM^CGM). Assessments at baseline and 5 months included a physical exam, metabolic and lipid panels, a review of diabetes medications, and psychological questionnaires. For the week following assessments, participants wore a blinded activity monitor and completed 3 days of 24-hour dietary recall. A subgroup also wore a blinded CGM. GEM^CGM participants significantly improved HbA_1c (from 8.9% to 7.6% [74-60 mmol/mol] compared with 8.8% to 8.7% [73-72 mmol/mol] for RC (<i>P</i> = .03). Additionally, GEM^CGM reduced the need for diabetes medication (<i>P</i> = .01), reduced carbohydrate consumption (<i>P</i> = .009), and improved diabetes knowledge (<i>P</i> = .001), quality of life (<i>P</i> = .01) and diabetes distress (<i>P</i> = .02), and trended to more empowerment (<i>P</i> = .05) without increasing dietary fat, lipids, or hypoglycemia. Confirming our prior research, GEM^CGM appears to be a safe, effective lifestyle intervention option for adults with suboptimally controlled T2D who do not take insulin.