Study protocol: glycaemic outcomes in people with type 2 diabetes initiating continuous glucose monitoring: the 2GO-CGM study

Claire S Lever; Jonathan A Williman; Alisa Boucsein; Antony Watson; Rachael S Sampson; Oscar T Sergel-Stringer; Celeste Keesing; Lynne Chepulis; Benjamin J Wheeler; Martin I de Bock; Ryan G Paul

doi:10.1007/s40200-023-01244-y

Study protocol: glycaemic outcomes in people with type 2 diabetes initiating continuous glucose monitoring: the 2GO-CGM study

J Diabetes Metab Disord. 2023 Jun 15;22(2):1779-1792. doi: 10.1007/s40200-023-01244-y. eCollection 2023 Dec.

Authors

Claire S Lever^{1

2

3}, Jonathan A Williman⁴, Alisa Boucsein⁵, Antony Watson⁶, Rachael S Sampson^{2

3}, Oscar T Sergel-Stringer⁵, Celeste Keesing^{2

7}, Lynne Chepulis¹, Benjamin J Wheeler^{5

8}, Martin I de Bock^{6

9}, Ryan G Paul^{1

2

3}

Affiliations

¹ Te Huataki Waiora, School of Health, University of Waikato, Hamilton, Aotearoa New Zealand.
² Waikato Regional Diabetes Service, Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand.
³ Aotearoa Diabetes Collective, Hamilton, Waikato New Zealand.
⁴ Department of Population Health, University of Otago, Christchurch, New Zealand.
⁵ Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
⁶ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
⁷ Pinnacle Midlands Health Network, New Plymouth, New Zealand.
⁸ Department of Paediatrics, Te Whatu Ora Southern, Dunedin, New Zealand.
⁹ Department of Paediatrics, Te Whatu Ora Health New Zealand Waitaha Canterbury, Christchurch, New Zealand.

Abstract

Purpose: Improving glycaemic control in type 2 diabetes (T2D) is essential to reducing social and health-economic burden of diabetes-related complications. Continuous glucose monitoring (CGM) has been established as beneficial in improving glycaemic control and reducing hypoglycaemia in people with type 1 diabetes, however data in T2D is limited. This study has been designed to assess the effect of initiating real-time CGM (rtCGM) on glycaemic control in a high-risk population of adults with T2D. Secondary objectives are to assess the cost-effectiveness and safety of rtCGM, and the effects of rtCGM on diet/lifestyle and the burden of diabetic complications, including cardiovascular risk.

Methods: This multicentre randomised controlled trial (RCT) will be conducted at three sites in New Zealand (Waikato, Christchurch and Dunedin). Eighty adults with T2D on insulin with suboptimal glycaemic control (HbA1c > 8.0% or 64 mmol/mol) will be randomised 1:1 to rtCGM or routine care with self-monitoring of blood glucose levels (SMBG) for three months. This intervention phase will be followed by a three-month continuation phase where SMBG group crossover to use rtCGM. Participants will then be invited to join the extension phase with continued use of rtCGM for a further 12 months. During the extension phase, both groups will independently titrate their insulin under the remote supervision of prescribing diabetes nurse specialists following an insulin titration algorithm. The primary outcome of the study is time in target glucose range (3.9-10 mmol/L or 70-180 mg/dL; TIR). Secondary outcomes include CGM metrics as per consensus statement recommendations, and HbA1c. Additional planned analyses include cardiovascular risk profile, incremental cost-effectiveness analyses, dietary patterns, and qualitative analyses.

Trial registration number: The trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12621000889853) on 8 July 2021 and the World Health Organisation International Clinical Trial Registry Platform (Universal Trial Number U1111-1264-5822).

Keywords: Continuous glucose monitoring; Health economics; Quality of life; Type 2 diabetes.