Nahid Karimi, DNP, FNP-BC

Abstract:

Background: Continuous glucose monitoring (CGM) improves glycemic control in individuals with non-insulin-treated type 2 diabetes (T2D); however, its adoption in endocrinology clinics remains low.Purpose: This quality improvement project assessed CGM use in achieving Hemoglobin A1C (HbA1C) reduction and Time-in-Range (TIR) improvement over six months in patients with T2D not receiving insulin. Methodology: A retrospective chart review was conducted at an endocrinology clinic in Los Angeles County, including individuals (≥18 years) with T2D and HbA1C >7% who did not initiate insulin therapy after CGM implementation. Descriptive statistics were used to analyze HbA1C and TIR over 6 months. Only complete cases (n = 9) were included in the final analysis, excluding patients with incomplete data (n = 1). An interrupted time series (ITS) was also conducted on two patients to assess HbA1C changes before and after CGM use, considering temporal trends and anti-hyperglycemic medication dosing. Evaluation of Outcomes: After six months of initial CGM use, eight out of nine patients achieved HbA1C reductions of ≥0.3%, but only one patient showed a ≥8% increase in TIR with recommended CGM use. ITS analysis on both patients showed an immediate HbA1C reduction following CGM initiation, followed by a gradual but non-significant HbA1C downward trend over time. These findings suggest that while CGM may contribute to early HbA1C improvements, sustained long-term reductions were not statistically significant within this small sample. Conclusion: CGM demonstrated potential in improving glycemic stability, with TIR reliability dependent on consistent use in non-insulin-treated patients with T2D and uncontrolled glycemia. Findings support increasing CGM uptake in endocrinology clinics for these patients. Future research should assess confounding factors, such as the role of anti-hyperglycemic medications, and evaluate the long-term clinical outcomes of CGM use in a larger sample of patients with poorly controlled T2D.

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