Sustained Real-Time CGM Use Associated With Lower HbA1c, and UACR Reduction in High-Risk Type 2 Diabetes

Sustained use of real-time continuous glucose monitoring (rtCGM) was associated with lower hemoglobin A1c (HbA1c) over 3 years and a later reduction in urinary albumin-creatinine ratio (UACR) among high-risk adults with type 2 diabetes, according to a comparative effectiveness study published in JAMA Network Open.

Kaiser Permanente researchers noted that rtCGM improves short-term glycemic control, but longer-term evidence on glycemia and kidney health is limited. They emulated a target trial, using inverse probability–weighted marginal structural models to estimate per-protocol outcomes among patients who started and continued rtCGM vs CGM-naive controls. Eligible adults were aged 19 years or older, had no prior CGM use, and had HbA1c greater than 8% or emergency department or inpatient treatment for hypoglycemia.

The study included 25,648 adults (2771 rtCGM initiators and 22,877 controls) with a mean age of 61.5 years and a mean baseline HbA1c of 9.5%. At 1 year, mean HbA1c was 1.1 percentage points lower in the rtCGM group than in controls (95% CI, −1.30 to −0.90). At 36 months, the difference was approximately 0.8 percentage points (7.83% vs 8.58%; P < 0.001).

UACR did not differ significantly between groups through 2 years. At 3 years, the mean UACR was 125.3 mg/g lower with sustained rtCGM use than in controls (153 vs 278 mg/g; P = 0.001). The investigators reported no association between rtCGM use and estimated glomerular filtration rate during follow-up.

Attrition was substantial: 44.3% of rtCGM initiators were censored for discontinuation and 18.7% of controls for starting CGM. The authors said residual confounding by factors such as motivation cannot be ruled out, that findings should be verified in other health care settings, and that confirmation in long-term randomized clinical trials is needed. The study was supported in part by an independent investigator trial award from Dexcom Inc.; the funders had no role in its design or conduct.

Source: Karter AJ, Parker MM, Finertie H, Nugent JR, Gilliam LK, Mahapatra A. Continuous glucose monitoring and long-term glycemic and kidney outcomes. JAMA Netw Open. 2026;9(10):e2637698. doi:10.1001/jamanetworkopen.2026.37698