glucose monitoring comparison in primary care

Conditions: Diabetes Mellitus, Type 2

Summary: this research trial will randomize 50 primary care clinics and 354 patients in accordance with their primary care clinic assignment to 2 different glucose monitoring strategies (smbg vs. cgm) and compare the effectiveness through a pragmatic clinic cluster randomized design, with active glycemic management in a "usual" primary care setting, over the course of a 12 month active study period.

the trial will evaluate the comparative effectiveness of smbg (self-monitoring of blood glucose, also known as blood glucose monitoring \[bgm\] or fingerstick blood glucose monitoring) vs. continuous glucose monitoring (cgm), in managing glucose levels in individuals with type 2 diabetes (t2d) using insulin, with or without other glycemic therapies, in a primary care setting. the study will use a 2-arm, parallel group, cluster-randomized trial over a 12-month period. 50 primary care clinics will be randomly assigned to either use smbg for glucose monitoring (25 clinics), with ongoing glycemic management provided by usual care in primary care, or cgm for glucose monitoring (25 clinics), with ongoing glycemic management provided by usual care in primary care using cgm and ambulatory glucose profile (agp) reports in a typical clinic setting. the study will use glycemic monitoring devices available to participants using real-world resources to cover the cost of the devices, and will be fundamentally pragmatic in nature. 354 patients (approximately 7/clinic) will be enrolled over 13 months (12 months of active intervention) with an intention-to-treat primary analysis.

Eligibility criteria:
inclusion criteria: 1. age 18 to 75 (inclusive) 2. diagnosis of type 2 diabetes 3. a1c 7.5% to 12% (inclusive) in the last 2 months. (if a1c is older than 2 months at the baseline visit, a point-of-care or lab a1c may be done for eligibility) 4. insulin use with or without other classes of glycemia medication use 5. no significant comorbidities that could impair the ability of a primary care team to manage diabetes, including but not limited to end stage renal disease, cognitive impairment, active cancer, and pregnancy 6. established care within the healthpartners care group, no plans to move within the next year, and willing to participate for the duration of the study 7. willing and able to follow procedures for collecting blinded cgm data at baseline, 6 and 12 months follow-up 8. willing to complete surveys at baseline, 3, 6, 9 and 12 months. 9. willing to use smbg or cgm, depending on randomization, in the way that their care team recommends and/or how they feel is most useful in managing their diabetes 10. not currently using personal cgm 11. not planning to become pregnant exclusion criteria: 1. unwillingness or inability to provide informed consent 2. deemed not suitable for participation in the study based on any other clinical criteria as determined by study investigator(s)

Keywords: type 2 diabetes continuous glucose monitor blood glucose monitor self-monitoring of blood glucose primary care glycemic control time in range diabetes distress insulin a1c glucose management comparative effectiveness