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

초록

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.

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