Long-Term Feedback Effect of FGM in Newly-Diagnosed T2D Patients

Diabetes self-management represents the cornerstone of successful and cost-effective diabetes care, reducing the occurrence of complications, hospital admissions and readmission as well as estimated lifetime health care costs related to a lower risk for complications. Recent advances in diabetic technology may help to address some of these issues : Flash glucose monitoring (FGM) is a novel system of interstitial glucose monitoring intended to replace the capillary blood glucose measurement which proved to ameliorate glycemic variability and quality of life, beyond the good precision, increased time in range, and ease of wear. However, FGM is not currently used as an educational tool in patients with newly diagnosis of T2D who are not on insulin therapy.

Therefore, the rationale for this three-armed parallel group randomized controlled trial is that the continuous flow of data from FGM and the visual display of moment-to-moment glucose levels as a trend could provide real-time feedback also in newly T2D patients, assessing which frequency of sensor is superior in enhancing mindfulness and in ameliorating of glycemic control ,quality of life and well-being perception.

The entire study participation will span approximately 6 months and will be performed in the facilities of Fondazione Policlinico Campus Bio-Medico University of Rome enrolling 42 participants. The intervention phase will last 12 weeks followed by more 12 weeks in the follow-up phase. Each participant will have a screening visit ( week -4), a baseline visit ( week -2), a randomization visit (week 0) and three follow up visits at week 12 and 23 and 24 for all the groups.

Every group will wear also a blinded device (Free Style Libre Pro IQ) for registration of glicemyc variability at the baseline visit and a the end of the study ; group 1 will wear it also between intervention and follow-up phase ( weeks 11-12).

All patients will be asked to fill out a food diary at both the intervention and follow-up phases. A high glycemic index meal will also be administered during the randomization visit ( week 0) in order to record the emotional state of study subjects in response to postprandial glycemic values. Randomization will be performed following a ratio equal to 1:1:1 and blocked for gender.

The primary outcome of the study is the difference in the means of time in range (TIR) at weeks 23-24 adjusted for baseline phase values. Secondary endpoints include the difference in TIR assessed at weeks 11-12 among the three groups and within the three groups as well as difference in A1c, HOMA IR, weight, body composition and oxidative stress among the groups. Quality of life/well-being perception/mindfulness will be investigated at week 0, week 12 and week 24 through several questionnaires.

Inclusion criteria

• Diagnosed with type 2 diabetes mellitus ( according to the ADA Guidelines ) within the past 12 months
• Must be taking only metformin as glucose lowering treatments,
• Older than 18 years,
• Body Mass Index equal or greater than 25 Kg/m^2,
• Must be able to provide written informed consent .

Exclusion criteria

• diagnosis of type 1 diabetes;
• glycated hemoglobin exceeding 8.5%
• alcohol or drug abuse/dependency
• antidiabetic therapy other than metformin;
• pregnancy (on-going or planned during the study);
• severe illness (physical or mental health);
• cognitive impairment;
• high dose steroids;
• hospitalized more than 2 times in past 12 months
• previous bariatric intervention or gastrectomy;
• pace maker use
• uncorrected vision impairment;
• already using a continuous glucose monitor or flash glucose monitor;
• any allergy to the component of the device.