CGM-guided personalized self-management intervention improves glycemic control and quality of life in older adults with type 2 diabetes: a randomized controlled trial

Continuous glucose monitoring (CGM) provides pattern-based glucose information that may support individualized diabetes self-management. However, glucose information alone may not lead to behavioral change, particularly in older adults with type 2 diabetes who have suboptimal glycemic control and may experience difficulties interpreting and applying CGM data. This study evaluated the effect of an Information–Motivation–Behavioral Skills (IMB) model-based personalized self-management program in which CGM-derived information was used as an individualized feedback tool for older adults with type 2 diabetes. A randomized controlled trial was conducted with 52 adults aged ≥65 years with type 2 diabetes and HbA1c ≥7.0%. Participants were randomly assigned to the intervention or control group. The intervention group received a 12-week IMB model-based personalized self-management program in which CGM-derived glucose information was integrated with individualized education, goal setting, and behavioral feedback. The primary outcome, HbA1c, was measured at baseline and after 12 weeks using the AFINION 2 point-of-care testing (POCT) analyzer (Abbott, USA). Secondary outcomes included diabetes self-efficacy, diabetes self-care activities, waist circumference, body mass index (BMI), subjective health status, and health-related quality of life. Data were analyzed using SPSS version 26.0. A total of 45 participants completed the study (intervention: n = 21; control: n = 24). Compared with the control group, the intervention group showed significantly greater improvement in HbA1c (Z = - 3.10, p = 0.001), diabetes self-efficacy (Z = - 4.89, p < 0.001), diabetes self-care activities (t = 14.02, p < 0.001), BMI (t = -2.34, p = 0.012), subjective health status (Z = - 3.10, p = 0.001), and health-related quality of life (Z = - 3.27, p < 0.001). HbA1c decreased from 8.16% to 7.49% in the intervention group, whereas it increased from 7.47% to 7.68% in the control group. The change in HbA1c differed significantly between the intervention and control groups (Z = - 3.10, p = .001). The integrated IMB model-based personalized self-management program supported by CGM was associated with improved glycemic control, diabetes self-efficacy, self-management behaviors, and health-related quality of life in older adults with type 2 diabetes. Because CGM was delivered together with multiple educational and behavioral components, these findings should be interpreted as the effect of the integrated program rather than the independent effect of CGM alone. KCT0009023. Registered on December 8, 2023, retrospectively.