Does Continuous Glucose Monitoring Use Prompt Greater Engagement in Self-Management? A Randomized Controlled Trial Focusing on Adults With Type 2 Diabetes

Abstract

Background: Continuous glucose monitoring (CGM) promotes glycemic benefits in adults with type 2 diabetes (T2D), including insulin users as well as noninsulin users, often with minimal professional support. To investigate whether these benefits may stem from increased user engagement in self-management, we conducted a randomized controlled trial comparing the impact of CGM versus self-monitoring of blood glucose (SMBG) on self-reported engagement and HbA1c in CGM-naïve adults with T2D. Methods: Potential participants completed the Impact of Glucose Monitoring on Self-Management Scale (IGMSS) and an HbA1c home test to confirm eligibility (>7.5%). N = 110 eligible participants were randomized to receive a FreeStyle Libre 3 (CGM arm) or a FreeStyle Precision Neo Blood Glucose Monitoring System (SMBG arm). The IGMSS and HbA1c home test were repeated after three months. Latent change score models estimated group differences in outcomes over time. Results: CGM users reported significantly greater engagement with T2D self-management than SMBG users (IGMSS total b = 0.61, P < .001), including greater gains on all three major subscales, capability (b = 0.76, P < .001), opportunity (b = 0.46, P = .001), and motivation (b = 0.66, P < .001). CGM users also saw a significant HbA1c drop of ~1% (9.2% to 8.3%, P < .001, d = .65), with less than half the reduction in SMBG users (8.9% to 8.4%, P = .065, d = .30). However, the effect of group on HbA1c change did not reach statistical significance ( P = .170), likely due to limited sample size. Conclusions: These findings suggest that introducing CGM to adults with T2D heightens users’ engagement with their own diabetes care and also improves glycemic control more than providing SMBG.

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