Strongest evidence yet backs CGMs without insulin

Clinical takeaway: Consider continuous glucose monitoring (CGM) for adults with type 2 diabetes who are not using insulin but remain above glycemic targets; CGM substantially increased time in range and improved A1c control in routine primary care settings.

CGMs are well established for insulin-treated diabetes, but evidence has been limited for the much larger population of patients with type 2 diabetes who do not use insulin. Roughly 20 million U.S. adults fall into this category, and current guideline support for CGM in these patients has lagged behind that for insulin users.

The randomized CONNECT trial enrolled 283 adults with type 2 diabetes from 22 U.S. primary care practices and followed them for 26 weeks. The study specifically focused on patients not using insulin, making the findings highly relevant to everyday diabetes management in primary care.

Patients assigned to CGM spent about five additional hours per day within their target glucose range compared with those receiving usual care. CGM users were also nearly twice as likely to achieve an A1c below 7%, a commonly used treatment goal.

Average glycemic control improved meaningfully as well. The difference in A1c reduction between groups was about 0.9 percentage points, exceeding the threshold generally considered clinically important. Researchers attribute the benefit in part to the real-time feedback CGMs provide, allowing patients to see how meals, physical activity, and other daily behaviors affect glucose levels.

The authors noted that previous studies in this population were smaller and less representative of routine care. By conducting the trial across primary care practices, where most patients with type 2 diabetes receive treatment, the investigators believe the results could help support broader guideline recommendations and insurance coverage for CGM use in non-insulin-treated diabetes.

“We hope this research will help strengthen national diabetes care guidelines and expand insurance coverage, making this technology more accessible to the millions of patients who could benefit from it,” said lead author Tamara Oser, MD in a press release.

Source: Oser TK, et al. (2026 Oct 14) N Engl J Med. Continuous Glucose Monitoring in Non-Insulin-Treated Type 2 Diabetes