Project Summary: Type 2 diabetes (T2D) is a significant health concern globally, with stagnant metabolic control despite increasing expenditure on endocrine care.
The COVID-19 pandemic further impeded diabetes management efforts.
This pilot study aimed to investigate the potential of dietary and lifestyle changes, coupled with continuous glucose monitoring (CGM), to improve health outcomes for patients living with T2D in North Central London (NCL), focusing on medication avoidance and the possibility of de-prescribing some medicines in patients who improved.
Eight primary care practices participated, recruiting 95 patients. Patients underwent a 6-week intervention, focusing on dietary and lifestyle modifications, alongside education from instant feedback from dietary choices from CGM technology. Eligible patients included those at the initiation stage requiring treatment for type 2 diabetes or requiring step-up therapy due to poor HbA1c levels. Insulin-using patients were excluded.
Training sessions were provided for clinicians on medication adjustment by a clinician with a special interest in lifestyle medicine, expertise in diabetes remission and CGM use. Both patients and clinicians completed surveys post-intervention, and HbA1c tests, weight and blood pressure were conducted before and a few weeks after CGM removal. Challenges such as incomplete data collection and time constraints were encountered. Results from the pilot show improvements in HbA1c, weight and blood pressure.
The pilot study clearly demonstrated that, in the short term, the utilisation of CGM and other supportive tools can effectively educate and motivate newly diagnosed patients and those with uncontrolled or stable hyperglycaemia to self-manage their condition and improve their diabetes outcomes.
This benefits both patients and the healthcare system through medication avoidance and in some patients a need for deprescribing. Summary of HbA1c outcomes HbA1c Summary Breakdown (n=70 patients with full dataset).
Results outcome % of patients with HbA1c improvement (based on a minimum of 5mmol/mol reduction) 64% Average HbA1c at start of pilot 70.0 mmol/mol.
Average HbA1c at end of pilot mmol/mol 60.6 mmol/mol.
Average improvement of HbA1c -9.8 mmol/mol NUMBER OF PATIENTS SUMMARY HbA1c improvement of 10mmol/mol or more 28HbA1c improvement of 5mmol/mol or more 45HbA1c worsened by > 5mmol/mol 5HbA1c stayed the same 20No. of patients achieving HbA1c < 48 mmol/mol 5No. of patients achieving HbA1c of < 42 mmol/mol 1.
Other benefits from the pilot included 69% of patients losing weight (n=52 complete data submitted) average weight loss for the 52 patients was 1.7kg range 0.4-10.5kg, marked improvement in blood pressure achieved by several patients and several medications stopped for both diabetes and hypertension.
