- Design
- Randomised, open-label trial in 22 primary care practices, 26 weeks
- Population
- 283 adults with type 2 diabetes not using insulin
- Primary outcome
- HbA1c at 26 weeks
- Effect
- 8.8%→7.2% vs 8.7%→8.0%; difference −0.9 points (95% CI −1.1 to −0.6)
The CONNECT trial, in NEJM, randomised 283 adults with type 2 diabetes not using insulin, cared for in 22 US primary care practices, to continuous glucose monitoring or routine care for 26 weeks. Baseline HbA1c was about 8.8%.
HbA1c fell to 7.2% with CGM and to 8.0% with routine care, an adjusted difference of 0.9 percentage points. Time in the 70–180 mg/dL range was 21 percentage points higher, and time in hypoglycaemia was slightly lower. There was no severe hypoglycaemia. The trial was open label and funded by a CGM manufacturer.
CGM has been standard for type 1 diabetes and increasingly for insulin-treated type 2. This trial suggests a benefit of similar size in people on oral or non-insulin injectable drugs, in ordinary primary care. A 0.9-point fall is comparable to adding a glucose-lowering drug.
For a patient above target who is motivated and can access sensors, CGM is now a reasonable option to discuss even without insulin. Cost is the main barrier in many settings, including India, and the trial lasted only six months.
- Consider CGM for patients with type 2 diabetes above target on non-insulin treatment who want to use it
- Agree in advance what the patient will do with the readings, such as adjusting meals or activity
- Review time in range alongside HbA1c at follow-up
- Discuss sensor cost openly; the benefit is meaningful only if the patient can keep wearing them
- Reassess at six months whether the patient is still using and benefiting from the device
Why it matters
CGM is no longer only for people on insulin.
Don't overread it
Six months, open label, manufacturer funded: durability and hard outcomes are unknown.
The statistics, in plain English
The difference of −0.9 points has an interval from −1.1 to −0.6, so even the smallest plausible effect is clinically useful. An open-label design can inflate behavioural effects, but HbA1c is an objective laboratory measure.
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