title: Heterogeneity of responses to real-time continuous glucose monitoring (RT-CGM) in patients with type 2 diabetes and its implications for application.
abstract: OBJECTIVE
  To characterize glucose response patterns of people who wore a real-time continuous glucose monitor (RT-CGM) as an intervention to improve glycemic control. Participants had type 2 diabetes, were not taking prandial insulin, and interpreted the RT-CGM data independently.
  
  
  METHODS
  Data were from the first 12 weeks of a 52-week, prospective, randomized trial comparing RT-CGM (n = 50) with self-monitoring of blood glucose (n = 50). RT-CGM was used in 8 of the first 12 weeks. A1C was collected at baseline and quarterly. This analysis included 45 participants who wore the RT-CGM ≥4 weeks. Analyses examined the RT-CGM data for common response patterns-a novel approach in this area of research. It then used multilevel models for longitudinal data, regression, and nonparametric methods to compare the patterns of A1C, mean glucose, glycemic variability, and views per day of the RT-CGM device.
  
  
  RESULTS
  There were five patterns. For four patterns, mean glucose was lower than expected as of the first RT-CGM cycle of use given participants' baseline A1C. We named them favorable response but with high and variable glucose (n = 7); tight control (n = 14); worsening glycemia (n = 6); and incremental improvement (n = 11). The fifth was no response (n = 7). A1C, mean glucose, glycemic variability, and views per day differed across patterns at baseline and longitudinally.
  
  
  CONCLUSIONS
  The patterns identified suggest that targeting people with higher starting A1Cs, using it short-term (e.g., 2 weeks), and monitoring for worsening glycemia that might be the result of burnout may be the best approach to using RT-CGM in people with type 2 diabetes not taking prandial insulin.
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland, USA. fondasj@gmail.com
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Fonda
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Salkind
authors.forename: M Susan
authors.initials: MS
authors.lastname: Walker
authors.forename: Mary
authors.initials: M
authors.lastname: Chellappa
authors.forename: Nicole
authors.initials: N
authors.lastname: Ehrhardt
authors.forename: Robert A
authors.initials: RA
authors.lastname: Vigersky
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin