Continuous Glucose Monitor Improves Glycemic Control in Youth-Onset Type 2 Diabetes

Background: Youth with type 2 diabetes (T2D) develop early treatment failure. Most patients do not self-monitor blood glucose (SMBG) levels at recommended frequency. Continuous glucose monitor (CGM) has been shown to improve glycemic control in pediatric T1D and adult T2D. Its feasibility and efficacy in youth-onset T2D is unknown. Hypothesis: Participants who wear the CGM >85% of the time will lower their HbA1c by at least 0.5%. Methods: T2D patients prescribed insulin were eligible to participate if their HbA1c was at least 8%. Participants were randomized to 3-months of SMBG or Dexcom G6 CGM, followed by 3 months of washout (SMBG) and 3-month crossover to the other treatment arm. Participants and their clinical providers agreed to not start new diabetes medications but could adjust insulin dosing or add on rapid-acting insulin if HbA1c >9% at follow-up. A nurse care manager provided coaching for the first 30 days of CGM use. The CGM-SAT satisfaction survey was administered at the end of CGM wear. Student t-test and Fisher’s exact test were used to compare differences in continuous and categorical variables between groups, respectively. A 5% level of significance was used. Results: out of 14 participants completed the study. Our cohort was 55% female. At enrollment, mean age was 17.4±2.0 years, diagnosis duration was 4.0±2.8 years, and HbA1c was 11.5±2.5%. The percentage of days with CGM data trended from 89% down to 73% between the 1st and 3rd month of CGM use (not statistically significant) . CGM use lowered HbA1c by 2.8% for the cohort (SMBG: -0.1%, CGM: -3.1%, P=0.005) and by 3.8% for those who wore the CGM >85% of the time (P=0.01) . The mean CGM item score was 3.7 ± 0.5, comparable to prior results reported in T1D youth. Conclusion: Consistent CGM use improves glycemic control in youth-onset type 2 diabetes in this pilot study. Not all patients experienced an improvement in HbA1c. A larger study is warranted to validate the findings of this study and to identify patients who are most likely to benefit from CGM use. Disclosure N.T.Chang: None. J.Smith: None. L.Chao: None. Funding Dexcom