Abstract
AIMS: Continuous glucose monitoring systems (CGM) and exercise trackers offer real-time feedback on the effects of lifestyle intervention on blood glucose. This randomized controlled trial aimed to examine whether an additional exercise tracker (Fitbit) would improve glycemic control, in combination with sequential CGM (FreeStyle Libre), in middle-aged patients with Type 2 Diabetes. METHODS: This 6-month prospective study included 158 patients, of whom 138 participants completed the protocol, with a median age of 58 (54, 62) years and HbA1c of 9.7% (8.8, 10.4). There were 69.6% participants on insulin therapy. Participants were randomly assigned to one of two groups: a group wearing a CGM alone (CGM, n = 73) or a group wearing both a CGM and a Fitbit INSPIRE HR (CGM-Fit, n = 65). All participants wore three sequential CGM (2 weekly for 6 weeks), coupled with diabetes education and diet counselling. RESULTS: Both groups demonstrated sufficient CGM data capture at each two weeks (89.8%, 90.8%, 92%), with an average wear time of 14 days and 6-7 scans per day. Overall, time-in-range increased (61%, 67%, 71%; p < 0.01) and time-above-range decreased (35%, 27%, 25%; p < 0.01). HbA1c reduced significantly (p < 0.0001) between baseline and 3 months by 1.5% in both groups, independent of weight changes. However, between 3 and 6 months, the CGM group experienced a rise in HbA1c of 0.7% (p < 0.0001) compared (p < 0.05) to the 0.4% rise (p < 0.0001) in the CGM-fit group. The CGM-Fit group maintained their physical activity levels, whereas the CGM group experienced a significant reduction (p < 0.01) in physical activity. CONCLUSIONS: The use of sequential CGM, guided by Diabetes counselling and dietary advice, significantly improved HbA1c. Using an exercise tracker may help sustain physical activity and glycemic control.