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NEW ORLEANS — In adults with type 2 diabetes (T2D) who are not treated with insulin, continuous glucose monitoring (CGM) provided substantial improvements in hyperglycemia compared with those receiving routine care, new research showed.
“These findings can help reshape diabetes management and expand treatment options for patients, improve glucose levels and A1c management for clinicians, and ultimately reduce diabetes-related complications,” said coauthor Thomas W. Martens, MD, of the International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, in a press statement about the study, presented this week at the American Diabetes Association (ADA) 2026 Scientific Sessions.
Although CGM is a highly recommended standard of care among people with type 1 diabetes and insulin-treated T2D, research is lacking on the benefits of CGM in patients with T2D who are not treated with insulin.
Even when treated with effective agents including SGLT2 inhibitors, GLP-1 receptor agonists (RAs), or other diabetes therapies, many of these patients can have elevated A1c levels that suggest potential benefit from CGM.
Multicenter CONNECT Trial
To compare outcomes among patients provided CGM vs standard care, Martens and colleagues conducted the CONNECT trial with 283 adults with T2D not taking insulin from 22 primary care practices in the US.
Patients were randomized 1:1 to a CGM device (Dexcom G7; n = 145) or routine care with standard blood glucose meter testing (n = 138). Both groups continued pre-study glucose-lowering medications and received education on diet and exercise, and had regular check-ins.
Patients had a mean age of 60 and a median diabetes duration of 10 years (range 1-37). Mean A1c levels were high, at 8.8%, and 31% of patients had an A1c ≥ 9%. Mean BMI was 33 kg/m2, and 13% of patients had previously taken insulin but had discontinued it more than 1 year before study enrollment.
In terms of treatment, 37% of participants were receiving an SGLT2 inhibitor, and 40% were receiving an incretin-based medication, such as a GLP-1 RA.
In total, 97% of the CGM group and 90% of the standard care group completed the study at the 26-week visit. Those in the CGM group had a substantial improvement in hyperglycemia, achieving a 1.6% reduction in A1c, compared with a 0.7% reduction in the routine care group, a difference of 0.9% (P < .001).
Treatment effect increased based on baseline A1c levels, with reductions of 0.6% with CGM vs 0.4% with standard care among patients with A1c < 8% at baseline, and reductions of 3.1% with CGM vs just 1.2% with standard care for those with baseline A1c ≥ 10%.
In addition, improvements in A1c ≥ 0.5% occurred in 82% of those in the CGM group vs 56% in the standard care group (P < .001), with 84% in the CGM group achieving an A1c < 8.0% vs 56% in the standard care group (P < .001).
A1c reductions were likewise higher with CGM use across groups in terms of use of glucose-lowering medications at baseline.
Notably, the amount of time spent within the glucose target range of 70-180 mg/dL was 5 hours greater in the CGM group vs routine care, with time-in-target range in the CGM group increasing from 29% at baseline to 62% vs 31% to 42% in the standard care group (P < .001) at weeks 13 and 26 combined.
“The greatest improvement was seen in participants with the highest baseline A1c and lowest time in range, who have the highest risk for vascular complications,” Martens said during his talk.
“And the benefit was observed in both users and nonusers of GLP-1 RA and SGLT2 inhibitor medications,” he added.
There were no reports of severe hypoglycemia in either group, and rates of other serious adverse events unrelated to CGM were similar.
Furthermore, those receiving CGM reported greater satisfaction with their management, in addition to reduced distress related to diabetes compared with the routine care group.
Results Have “Considerable Public Health Importance”
Beck noted that although some small studies have shown benefits of CGM in patients with T2D not treated with insulin, “there has not been a large, randomized trial of CGM in this patient population.”
“Consequently, CGM is not covered by Medicare or most commercial insurers for patients with [T2D] not using insulin, which represents about 75% of adults in the US with [T2D], or about 20 million patients,” he told Medscape Medical News.
Considering that “many of those patients are not reaching glycemic targets even with GLP-1 or SGLT2 drugs, these results have considerable public health importance,” he said.
Diabetes a Self-Managed Condition
Commenting on the study, Josh Neumiller, PharmD, the Allen I. White Distinguished Professor in the College of Pharmacy and Pharmaceutical Sciences at Washington State University, Spokane, noted that the extension of CGM to people with T2D who are not taking insulin seems a natural progression of its benefits.
There’s been an evolution over the last couple of years in the diabetes standards of care to include this population, he noted, but there's still a lot of interest in whether people who are taking non-insulin glucose-lowering therapies for T2D can also benefit.
“This study really helps us answer that question, [showing] that just having that CGM on board can, in and of itself, lower A1c, nearing 1% in the trial,” he told Medscape Medical News.
“As a pharmacist and a diabetes care and education specialist, I think what it really highlights to me is that diabetes is largely a [self-managed] condition,” said Neumiller.
When people can see on the CGM what their lifestyle choices are doing and how their medications are affecting their glucose, it is — “as we've suspected” — beneficial in terms of their overall glycemic management, he explained. This study “really helps from an evidence standpoint to inform that.”
The study was funded by Dexcom. Martens has reported consulting or other relationships with Abbott, Dexcom, Lilly, Medtronic, Sanofi, MannKind, Novo Nordisk, Insulet, Tandem, Sequel, Luna, Zealand, and Amgen. Beck and Neumiller have reported no relevant financial relationships.
