Diabetes

Impact of Continuous Glucose Monitoring Versus Blood Glucose Monitoring to Support a Carbohydrate-Restricted Nutrition Intervention in People with Type 2 Diabetes

Ketogenic interventions supported by remote, continuous care have shown positive outcomes in individuals with type 2 diabetes (T2D). This study compared the use of continuous glucose monitoring (CGM) versus blood glucose monitoring (BGM) in guiding dietary choices and medication management during a medically supervised ketogenic diet program.

A total of 163 adults with T2D (average duration: 9.7 years; baseline HbA1c: 8.1%) were randomized into the CGM group (n = 81) and the BGM group (n = 82)

Participants followed a ketogenic intervention with remote continuous care, supported by CGM or BGM data. Glycemia, medication use, dietary intake, and weight were assessed at baseline, month 1, and month 3.

Key Findings:

• Improved glycemic control:
  Time in range (70–180 mg/dL) increased significantly in both groups from baseline to month 3: CGM group, from 61% to 89%; BGM group, from 63% to 85% (P < 0.001).
  HbA1c decreased by at least 1.5% in both groups (P < 0.001).
• Reduced medication use:
  Diabetes medications were de-intensified, as reflected by reduced medication effect scores (P < 0.001).
• Dietary changes and weight loss:
  Total energy and carbohydrate intake decreased significantly (P < 0.001). Participants in both groups achieved clinically significant weight loss (P < 0.001).
• No significant difference between CGM and BGM:
  While both groups experienced substantial improvements, there were no significant differences in time in range, HbA1c reduction, or other outcomes between the CGM and BGM arms.

In summary, in this study both CGM and BGM effectively supported glycemic control, weight loss, and medication reduction in people with T2D following a medically supervised ketogenic diet program. While CGM may provide additional metrics for care teams, BGM remained a viable option for improving outcomes in this population.