Improving glycaemic control in primary care for Tongan adults with type 2 diabetes through the use of continuous glucose monitoring and holistic support: a pilot study

INTRODUCTION: In Aotearoa New Zealand, Pacific peoples, including Tongans, experience disproportionately higher rates of type 2 diabetes and related complications. There is an urgent need for innovative, culturally appropriate interventions to improve outcomes. AIM: This study aimed to determine the impact of continuous glucose monitoring devices with cultural wrap-around support on medium-term glycaemic control and other type 2 diabetes biomarkers in Tongan adults with high-risk type 2 diabetes. METHODS: Twenty-two Tongan adults with HbA1c ≥60 mmol/mol were invited to participate in a 6-month pilot intervention study involving 4 weeks of continuous glucose monitoring wear at baseline and 2 weeks at 3-months, alongside wrap-around care delivered by a Tongan kaiāwhina (support health worker). The primary endpoint was 3-month HbA1c. Clinical (glycated haemoglobin, lipids, estimated glomerular filtration rate, urinary albumin to creatinine ratio) and psychosocial (Diabetes Self-Management Questionnaire, measured at baseline and 3 months) outcomes were measured at baseline, 3, and 6 months. RESULTS: Nineteen participants completed the study through to 6 months. Mean HbA1c significantly decreased from 80.2 ± 19.4 mmol/mol at baseline to 68.6 ± 14.2 mmol/mol at 3 months, with reductions maintained at 6 months. No significant changes in lipids or renal function were observed. Diabetes Self-Management Questionnaire scores increased from 4.9 ± 0.8 to 6.0 ± 1.0 (P < 0.001). DISCUSSION: Culturally tailored continuous glucose monitoring-based interventions have the potential to support Tongan adults with understanding, optimising, and managing type 2 diabetes.