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| The Capital Brief | October 15 | |
| Diabetes Care Edition |
| In a Randomized Trial, Glucose Monitors Lowered A1C for Type 2 Diabetes Without Insulin |
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| Continuous glucose monitors are standard for many people who use insulin. Whether they help people with type 2 diabetes who do not use insulin has been less clear. A randomized trial now offers stronger evidence. The CONNECT trial was published in the New England Journal of Medicine on October 14, led by researchers at the University of Colorado Anschutz and the Jaeb Center for Health Research. It enrolled 283 adults with type 2 diabetes not treated with insulin at 22 primary care practices in the United States, and followed them for 26 weeks. Participants were randomly assigned to use a Dexcom G7 continuous glucose monitor or to continue routine care with fingerstick blood glucose testing. Both groups received diet and exercise education and stayed on their usual medications. According to the investigators and sponsor, A1C fell 1.6 points in the monitor group from an average of 8.8%, 0.9 point more than with routine care. Time spent in the target glucose range was about 62% with monitors versus 41% with routine care, roughly five more hours a day. This was a randomized trial, but it was relatively small, lasted six months and was sponsored by the device maker. Results were first presented in June and now appear as a peer-reviewed paper. The useful idea is that real-time feedback may help people see how daily choices affect blood sugar. This edition explores the evidence, not a device recommendation. Diabetes management decisions belong with a clinician. |
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| A continuous glucose monitor uses a small sensor under the skin to measure glucose every few minutes. Readings are sent to a phone or receiver, showing trends and responses to meals and activity. Most people with type 2 diabetes do not use insulin and manage with oral or injectable medications. For them, fingerstick testing is often infrequent or not recommended. Insurance coverage for monitors in this group has been limited. An earlier observational study, covered in this newsletter, linked sustained monitor use to better outcomes in high-risk type 2 diabetes. CONNECT tested the question with a randomized design. |
| 02 | How the trial was designed | |
| The trial enrolled 283 adults at 22 primary care practices. Participants had an average age of about 60, and about a third were from racial or ethnic minority groups. Average starting A1C was 8.8%, and about 31% had A1C of 9% or higher. About 40% were taking GLP-1-based medications and about 37% SGLT2 inhibitors. Participants were randomly assigned to a monitor or routine care with a fingerstick meter. The main outcome was change in A1C after 26 weeks. 265 participants completed the trial. |
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| A1C fell 1.6 points in the monitor group, 0.9 point more than in the routine care group, according to the investigators and sponsor. Time in the target range of 70 to 180 mg/dL was about 62% with monitors and 41% with routine care. The difference appeared within the first weeks and lasted through 26 weeks. About 68% of monitor users reached an A1C below 7.5%, and 46% below 7.0%, according to the sponsor. Monitor users reported greater satisfaction with glucose monitoring and less diabetes distress. Participants wore the sensor most of the time throughout the study. Confidence intervals and full safety data are reported in the published paper. |
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| According to conference coverage, people with starting A1C above 10% saw especially large reductions. Benefits were also reported among people taking GLP-1 drugs and SGLT2 inhibitors. People taking no diabetes medications also improved. The sponsor said benefits were consistent across age, sex, race and ethnicity, income and education. Subgroup results in small trials should be interpreted cautiously. Primary care settings make the findings relevant to where most diabetes care happens. Real-world results may differ from trial conditions. |
| 05 | Why monitors might help | |
| Seeing glucose rise after a meal can prompt changes in food choices or portions. Real-time data can show the effects of walking after meals. Clinicians can use monitor data to adjust treatment more precisely. Feedback may increase motivation and engagement. Monitors can also detect patterns that fingerstick tests miss. The trial did not isolate which of these factors mattered most. Benefits depend on people using the information. |
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| The trial was relatively small, with 283 participants. It lasted 26 weeks; a 12-month extension is underway. It tested one device brand and was sponsored by its maker, Dexcom. Participants and clinicians knew who was using a monitor. The figures here come from investigator and sponsor reports; details should be checked in the published paper. The trial measured A1C and glucose patterns, not long-term complications. Cost and insurance coverage were not addressed. |
| 07 | What people with diabetes can do | |
| Ask your clinician whether a continuous glucose monitor could help your diabetes management. Check insurance coverage, which varies by plan and treatment. Over-the-counter monitors are available, but discuss how to interpret data with a clinician. Use readings to learn how meals, activity and sleep affect your glucose. Share data with your care team at visits. Continue taking prescribed medications unless your clinician advises a change. A monitor is a tool, not a substitute for overall care. |
| 08 | The long view on diabetes technology | |
| Diabetes tools are becoming more accessible to people beyond those using insulin. This trial suggests monitors can meaningfully lower A1C for people with type 2 diabetes not on insulin. For individuals, practical questions include: Would real-time data change my habits? Is a monitor covered? How will I use the information? For health systems and insurers, the findings may inform coverage decisions. For researchers, longer and independent studies would strengthen the evidence. The long-view idea is that visible feedback can make invisible changes concrete. What you can see, you can manage. |
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| The Takeaway | | 1 | In the CONNECT randomized trial of 283 adults with type 2 diabetes not on insulin, continuous glucose monitors lowered A1C 0.9 point more than routine care over 26 weeks. | | 2 | Time in target range was about 62% with monitors versus 41% with routine care. | | 3 | Participants reported higher satisfaction and less diabetes distress. | | 4 | The trial was small, short and sponsored by the device maker. | | 5 | The findings support considering monitors with a clinician, not a guarantee of results. | | |
Stay patient, stay curious,
T.C. Brown
Editor, True Capital Talk |
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| Sources & Further Reading |
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| For educational and informational purposes only. Nothing here is a diagnosis, device recommendation, or individualized medical advice. Talk to a qualified clinician about diabetes management. |
