Exploring Combined Use of Continuous Glucose Monitoring and Anti-Diabetes Medications on Glycaemic Control for People With Type 2 Diabetes Not Using Insulin

Abstract

Introduction: Continuous glucose monitoring (CGM) offers a detailed view of glycaemic management, potentially enhancing the effectiveness of non-insulin, anti-diabetes medications. This study aimed to evaluate whether CGM use in combination with anti-diabetes medications is associated with changes in A1c among people with type 2 diabetes not using insulin. Materials and Methods: This was a retrospective, observational analysis of administrative claims and linked laboratory data from Optum's Clinformatics Data Mart database. The study observation period covered 01/07/2018 through 30/06/2023 with 6-month baseline and follow-up periods. CGM use in conjunction with ≥ 1 of five anti-diabetes medication classes: metformin, sulfonylureas, sodium-glucose cotransporter-2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors and/or glucagon-like peptide-1 receptor agonists (GLP-1 RAs) was required. The primary outcome was change in A1c from baseline. Linear regression models tested the main and interaction effects of CGM and each anti-diabetes medication. Results: Overall, 52,394 CGM-naïve adults with non-insulin-treated type 2 diabetes using anti-diabetes medications were identified (4086 CGM users; 48,308 CGM non-users). CGM use was associated with a –0.45% greater A1c change among CGM users compared to CGM non-users (p < 0.0001). After adjusting for covariates, CGM users experienced greater A1c reductions vs. CGM non-users with all medications, but statistically significant interactions showed that for DPP-4 inhibitors, GLP-1 RAs and sulfonylureas, there were greater decreases in A1c for CGM users vs. CGM non-users who were taking the medication compared to CGM users vs. CGM non-users who were not taking the medication. A1c change between CGM users vs. CGM non-users did not vary by metformin or SGLT2 inhibitor use. Discussion: The findings suggest that CGM use could augment the glycaemic benefits of anti-diabetes medications in people with non-insulin treated type 2 diabetes. These results support broader adoption of CGM.