Remote Application and Use of Real-Time Continuous Glucose Monitoring by Adults with Type 2 Diabetes in a Virtual Diabetes Clinic

Abstract

The Onduo Virtual Diabetes Clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists. Adults with T2D ( n = 594) who were evaluated by a VDC endocrinologist, remotely prescribed and mailed a real-time continuous glucose monitoring (rtCGM) device and used ≥1 sensor completed a CGM satisfaction questionnaire. The CGM satisfaction score was 4.5 ± 0.8 out of 5. Most respondents (94.7%) agreed/strongly agreed that they were comfortable inserting the sensor remotely and that rtCGM use improved understanding of the impact of eating (97.0%), increased diabetes knowledge (95.7%), and helped improve diabetes control when not wearing the sensor (79.4%). HbA1c ( n = 372) decreased from 7.7% ± 1.6% to 7.1% ± 1.2% ( P < 0.001; 10.2 months). These data suggest that it is feasible to provide rtCGM directly to individuals with T2D through a VDC without in-office training. Intermittent use of rtCGM was well-received by adults with T2D and was associated with improvement in HbA1c.

Diabetes and Frailty: An Expert Consensus Statement on the Management of Older Adults with Type 2 Diabetes

“…Remote blood glucose monitoring linked to web-based cloud technologies allows for the transfer of continuous glucose monitoring (CGM) data directly to healthcare professionals (e.g. intermittent CGM) [73,74]. However, the suitability of these telemedicine activities for the individual should be carefully considered, as they may not be effective in all cases [71,75].…”

Type 2 Diabetes and the Use of Real-Time Continuous Glucose Monitoring

“…In a study by Beck et al, use of rtCGM (Dexcom G4 with 505 software) in T2D patients on MDI showed a high level of satisfaction with CGM (4.3 with a scale of 1-5) and a low "hassle" subscore 24 . Other evaluations of patient-reported outcomes have found high levels of use, good satisfaction, and a better understanding of their glucose patterns, among other benefits 56,57 .…”

“…Telemedicine has greatly expanded during the COVID-19 pandemic, and the role of CGM in communicating patient data to providers has been crucial. This will likely remain an important tool in maximizing patient access options and improving communication with providers 25,26,56 .…”

Episodic Real-Time CGM Use in Adults with Type 2 Diabetes: Results of a Pilot Randomized Controlled Trial

“…A randomized study by Cox et al [29] looked at the benefit of a formal, group-oriented, structured education program in conjunction with rtCGM (worn for five sessions) in 30 subjects with early T2D and found that participants using rtCGM successfully modified their diets and lowered their HbA1c on the basis of their CGM data and the structured education. Glycemic benefits were also observed for adults with T2D who used rtCGM intermittently on an individualized schedule and engaged with a diabetes coach via a virtual diabetes clinic; greater benefit was observed for those who used rtCGM for more than 30 days across approximately 5 months [30,31]. Accordingly, there is additional need to ascertain if benefits of episodic rtCGM use in non-insulin-using adults with poorly controlled T2D can be observed outside of a structured coaching program and using a more conventional (and reimbursable) monitoring approach.…”