Continuous glucose monitoring may lower mortality risk in diabetic patients on insulin

by European Association for the Study of Diabetes

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People with type 2 diabetes (T2D) who began using continuous glucose monitoring (CGM) while receiving basal insulin had a 44% lower risk of dying from any cause after one year than those who did not use CGM, according to an analysis of patient data being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan, Italy, Sept. 28–Oct. 2. After two years, their risk was 35% lower.

The findings provide the first evidence of an association between advanced CGM technologies and a lower risk of death in people with T2D receiving basal insulin, with or without noninsulin diabetes medications. They also show an association with a reduced risk of cardiovascular events, researchers say.

Estimates suggest that around 7% of the 405 million people with T2D, or nearly 30 million people globally, require insulin therapy. Keeping glucose levels within the target range can be difficult. Over time, consistently high glucose levels can increase the risk of serious complications, including heart disease, blindness and stroke.

CGM uses a small sensor worn on the skin to measure glucose levels and transmit the readings to a mobile device, dedicated reader or automated insulin delivery system. This allows people to monitor their glucose levels at all times, helping them make informed adjustments to their lifestyle or insulin treatment.

CGM has transformed care for people with type 1 and type 2 diabetes and has been shown to improve blood glucose control, including by reducing episodes of hypoglycemia (dangerously low blood sugar levels). However, its potential role in reducing other long-term complications in people with T2D is less clear.

To find out more, researchers from Abbott and collaborating institutions used the Truveta platform, a database that includes anonymized electronic health records of more than 140 million Americans. They assessed the risk of death from any cause, as well as first and recurrent macrovascular events—including heart attack, heart failure, stroke or transient ischemic attack (TIA), and peripheral artery disease—in adults with T2D receiving basal insulin therapy between Jan. 1, 2017, and March 18, 2024.

The target trial emulation study compared 13,935 patients who filled a first prescription for CGM with 13,935 non-CGM users. The groups were matched on 29 patient characteristics at the start of the study to reduce confounding. These included age, sex, ethnicity, duration of diabetes, severity of diabetes complications, blood sugar control as measured by HbA1c levels, other health conditions, medication use, frequency of health care use and use of blood glucose monitors. Participants' average age was 58, and 47% were female.

Overall, CGM use was associated with a lower risk across all outcomes studied at both one year and two years.

At 12 months, CGM users were 44% less likely to die from any cause than those not using CGM, with death occurring in 1.16% of CGM users compared with 2.09% of non-CGM users. At 24 months, the risk of death from any cause was 35% lower among CGM users (2.12% compared with 3.26%).

Similarly, the risk of experiencing a new macrovascular event was 26% lower among CGM users at 12 months than among non-CGM users (1.03% compared with 1.39%), and 24% lower at 24 months (1.64% compared with 2.17%).

The analysis also found that the rate of recurrent macrovascular events was 35% lower among CGM users at 12 months and 36% lower at 24 months.

The rate of heart failure hospitalizations was around half as high among CGM users at both 12 months (54% lower) and 24 months (47% lower).

The findings remained consistent across several sensitivity analyses, including analyses that excluded the COVID-19 period and deaths occurring within the first 90 days.

"Our study suggests that CGM can make a real difference to the long-term health of people living with type 2 diabetes who require insulin and may help reduce the risk of early death," said professor Jochen Seufert of the University Hospital of Freiburg in Germany, who led the research.

"These findings strengthen the case for expanding access to CGM for people with type 2 diabetes on basal insulin therapy who could benefit from it. It is vital that we work toward fair and equitable access to diabetes technology, alongside the support people need to use it effectively, so that no one is left behind."

The authors point out that, as an observational study, the research cannot determine what specifically caused the lower rates of cardiovascular events and death. The possibility of unmeasured confounding cannot be excluded, despite participants being matched on 29 factors that could affect the results.

They also acknowledge other limitations, including that changes to medications and other clinical measures over time were not examined during follow-up. In addition, the study population may not be representative of all adults with T2D receiving basal insulin. They say larger prospective studies are needed to confirm and build on the findings.

Key medical concepts

Continuous Glucose MonitoringAll-Cause MortalityDiabetes Type 2

Clinical categories

EndocrinologyCommon illnesses & Prevention Provided by European Association for the Study of Diabetes Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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