Grant: Project Grant

Continuous Glucose Monitoring (CGM) is a wearable sensor that provides people with their glucose levels on-demand, without painful fingersticks. The glucose information can be accessed on a cell phone, and is like knowing where a glucose level is, where it was, and where it is headed. This information can help people with diabetes adjust activity and diet to lower their glucose levels in a safe and effective way. CGM is best studied in those with diabetes on insulin, where CGM helps with figuring out the dose of insulin injections. For those with type 2 diabetes, most are not on insulin, the value of CGM lies in improving day-to-day diet and activity. We have recently shown that CGM can improve 3-month diabetes control in adults with type 2 diabetes not on insulin, as well as improving how confident people are with their diabetes care. However, two key questions remain: Can the benefits be sustained up to 12 months? And can we get away with using fewer of these expensive sensors, perhaps by using them episodically (e.g.: as "refreshers" once every 3 months) instead of back-to-back? SUSTAIN-CGM is a randomized trial that will take people with type 2 diabetes, not on insulin, who need more help with improving glucose levels. People will be randomly assigned to episodic CGM versus no CGM, and we will examine their glucose control at 12 months. SUSTAIN-CGM will also examine whether using CGM this way provides good value-for-money for the health care system, and the key things that can help or hinder people from maintaining good diabetes self-care using CGM, from the patient-perspective. This information will help us to decide where CGM fits into diabetes care for adults with type 2 diabetes not on insulin, and will be important to future guidelines laying out "standards" of diabetes care for health care providers. Our findings will also be used to develop tools for people with diabetes and their providers, to help them get the most value out of CGM.