Short-term CGM as a tool to optimize glycemic control and defer intensive insulin therapy in people with poorly controlled type 2 diabetes: a Belgian real-life study.

Abstract

Objective: Continuous glucose monitoring (CGM) benefits type 2 diabetes (T2D) patients on multiple daily insulin injections (MDI), but its role in non-intensive insulin therapy remains underexplored. This study evaluates whether a short-term CGM non-blinded can postpone the escalation to multiple daily insulin injections in people with poorly controlled T2D.

Methods: This retrospective real-world study analyzed data from 309 adults with T2D in primary care who used a 10 or 14-day CGM (2020-2024). The primary objective was to assess CGM's impact on therapy escalation, particularly to MDI. The secondary objective was to identify factors predicting the intensification of glucose-lowering therapy (GLT).

Results: Among the 309 participants (median age: 65 [56-73] years, diabetes duration: 16 [11-23] years, baseline HbA1c: 8.6% [70 mmol/mol]), 91.3% were deemed unsuitable for MDI based on CGM results (non-MDI GLT group, n = 282). In this group, 76% achieved an HbA1c-GMI differential > 0.5%, and 54% >1.0% after 14 day-CGM. Basal insulin use decreased slightly (70% to 64%, p = 0.13), while twice-daily insulin increased (12% to 18%, p = 0.02). GLTs remained largely unchanged.

Conclusion: A short-term CGM prevented MDI escalation in 91.3% of poorly controlled T2D adults, reinforcing its role as a cost-effective strategy. CGM likely improved self-management behaviors, as evidenced by frequent HbA1c-GMI differentials, reflecting better management of hyperglycemia. These findings highlight CGM as a practical behavioral and therapeutic tool in diabetes care.