Efficacy of Real-Time Continuous Glucose Monitoring to Improve Effects of a Prescriptive Lifestyle Intervention in Type 2 Diabetes: A Pilot Study

IntroductionOptimising patient adherence to prescribed lifestyle interventions to achieve improved blood glucose control remains a challenge. Combined use of real-time continuous glucose monitoring systems (RT-CGM) may promote improved glycaemic control. This pilot study examines the effects of a prescriptive lifestyle modification programme when combined with RT-CGM on blood glucose control and cardiovascular disease risk markers.MethodsTwenty adults (10 men, 10 women) with obesity and type-2 diabetes (T2D) (age 60.55 8.38 years, BMI 34.22 4.67kg/m(2)) were randomised to a prescriptive low-carbohydrate diet and lifestyle plan whilst continuously wearing either an RT-CGM or an offline-blinded' monitor (control) for 12weeks. Outcomes were glycaemic control (HbA1c, fasting glucose, glycaemic variability [GV]), diabetes medication (MeS), weight, blood pressure and lipids assessed pre- and post-intervention.ResultsBoth groups experienced reductions in body weight (RT-CGM - 7.44.5kg vs. control - 5.5 +/- 4.0kg), HbA1c (- 0.67 +/- 0.82% vs. - 0.68 +/- 0.74%), fasting blood glucose (- 1.2 +/- 1.9mmol/L vs. - 1.0 +/- 2.2mmol/L), LDL-C (- 0.07 +/- 0.34mmol/L vs. - 0.26 +/- 0.42mmol/L) and triglycerides (- 0.32 +/- 0.46mmol/L vs. - 0.36 +/- 0.53mmol/L); with no differential effect between groups (P 0.10). At week12, GV indices were consistently lower by at least sixfold in RT-CGM compared to control (CONGA-1 - 0.27 +/- 0.36mmol/L vs. 0.06 +/- 0.19mmol/L; CONGA-2 - 0.36 +/- 0.54mmol/L vs. 0.05 +/- 2.88mmol/L; CONGA-4 - 0.44 +/- 0.67mmol/L vs. - 0.02 +/- 0.42mmol/L; CONGA-8 - 0.36 +/- 0.61 vs. 0.02 +/- 0.52mmol/L; MAGE - 0.69 +/- 1.14 vs. - 0.09 +/- 0.08mmol/L, although there was insufficient power to achieve statistical significance (P 0.11). Overall, there was an approximately 40% greater reduction in blood glucose-lowering medication (MeS) in RT-CGM (- 0.30 +/- 0.59) compared to control (0.02 +/- 0.23).Conclusion p id=Par4This study provides preliminary evidence that RT-CGM may be an effective strategy to optimise glucose control whilst following a low-carbohydrate lifestyle programme that targets improved glycaemic control, with minimal professional support.Trial RegistrationAustralian New Zealand Clinical Trials Registry identifier, ANZTR: 372898.Funding p id=Par5 Grant funding was received for the delivery of the clinical trial only, by the Diabetes Australia Research Trust (DART).