Sustained Continuous Glucose Monitoring Linked to Lower HbA1c and Albuminuria in Type 2 Diabetes

A comparative effectiveness study in JAMA Network Open evaluated sustained real-time continuous glucose monitoring (rtCGM) in 25,648 adults with type 2 diabetes. Eligible participants had no previous CGM use and either HbA1c above 8% or emergency department or inpatient treatment for hypoglycemia. Researchers emulated a target trial using inverse probability–weighted models, comparing 2,771 rtCGM initiators with 22,877 temporally matched controls over up to 36 months. Mean baseline HbA1c was 9.5%.

At 36 months, estimated HbA1c was 7.83% with rtCGM versus 8.58% among controls, approximately 0.8 percentage points lower (P < .001). Urinary albumin-creatinine ratio (UACR) did not differ significantly initially but was 125.3 mg/g lower with rtCGM at 36 months (difference 95% CI, −196.6 to −54.0 mg/g; P = .001). Estimated glomerular filtration rate did not differ during follow-up.

These findings suggest sustained rtCGM use is associated with durable glycemic improvement in high-risk patients, but do not establish prevention of kidney disease progression. The study was observational, and substantial protocol-related censoring occurred: 44.3% of rtCGM participants discontinued use, while 18.7% of controls initiated CGM. Residual confounding and informative censoring remain concerns despite statistical adjustment. Kidney findings concern surrogate markers rather than clinical kidney outcomes; only the abstract was available for this update.