CGM with low-carb nutrition counselling boosts glycaemic control in T2DM

The combination of continuous glucose monitoring (CGM) and low-carbohydrate nutrition counselling can help improve glycaemic control in patients with type 2 diabetes mellitus (T2DM), according to a recent study.

“As CGM technology evolves and carbohydrate restriction is increasingly accepted as a powerful tool to support T2DM self-management, this program may be a scalable and sustainable strategy to help and empower patients with T2DM to achieve glycaemic control,” the researchers said.

The 12-month, pragmatic, randomized quality improvement study included 1,584 T2DM patients (mean age 63.3 years, 46.71 percent women) receiving appropriate primary care. Participants were randomized to receive usual care (UC) or enhanced care (EC); those who had glycated haemoglobin (HbA1c) >7.5% (57 mmol/mol) were deemed high-risk (HR).

UC-HR patients (n=197) received routine care while EC-HR patients (n=185) were given an intermittently viewed CGM device along with personalized low-carbohydrate nutrition counselling. Over 12 months of observation, mean HbA1c decreased by 0.41-percent more in EC-HR than in UC-HR participants. The absolute difference of 4.5 mmol/mol in HbA1c reduction was statistically significant (p=0.04). [J Med Internet Res 2022;24;e31184]

The researchers pointed out, however, that only 61 of 185 EC-HR patients provided consent for data repository and thus were the only ones to participate in the EC program.

In this subgroup, the CGM device with nutritional counselling led to a significant 1.1-percent drop in HbA1c at 12 months relative to baseline (p<0.01). Use of absolute HbA1c measurements yielded the same results (74.9 to 62.8 mmol/mol; p<0.01), though no significant change in body mass index was reported (37.3 to 36.7 kg/m²; p=0.06).

In follow-up semistructured interviews, the researchers assessed participant perceptions of the EC program in 21 EC-HR patients. Thematic analysis revealed three main ways by which the combined intervention improved glycaemic control.

Participants reported that using the CGM device and reviewing its readings with their dietician helped them better understand how different types of food affected their blood glucose levels in different ways. Moreover, CGM allowed patients to relate their mood, sleep patterns, and energy levels with their intake, allowing them to make better dietary choices moving forward.

Moreover, participants liked the ease of using CGM, allowing them to monitor their blood glucose in real-time, without disrupting their daily activities. They also overwhelmingly preferred it to finger-prick blood tests.

Finally, participants also agreed that adopting a low-carbohydrate diet was not difficult. However, some challenges remained, including the preference and craving for high-carbohydrate foods, the sheer convenience of highly-processed foods, and the difficulty in accessing and preparing low-carbohydrate foods.

“Our findings demonstrate that the use of CGM technology and personalized nutrition counselling focused on dietary carbohydrate restriction can help patients with suboptimally controlled T2DM to improve HbA1c levels without increasing antihyperglycemic medication use,” the researchers said.