This study examined if a sequential continuous glucose monitoring (CGM) program using a Freestyle Libre would improve glycaemic control with or without an exercise tracker among middle-aged (50 to 65 years) patients with type 2 diabetes. We randomized 94 subjects (mean 57±4 years and HbA1c 10.1±1.6%) into a group wearing CGM alone (CGM-alone, n=52) and another group wearing CGM and an exercise tracker (CGM-Fit, n=42) . We measured HbA1c at pre-randomization, at 4 months and 6 months from randomization. All subjects wore the CGM every 2 weekly sequentially for the first 6 weeks and received diabetes counselling and professional dietary advice based on the CGM profile. Diabetes treatment was adjusted by the diabetes educator as appropriately. Those in the CGM-Fit group received a Fitbit watch with app-based guidance on an exercise regime. At baseline (pre-randomization) , there was no between-group difference in the HbA1c levels. At 4-month post-randomization, the HbA1c improved by 1.6±1.5% in CGM-alone (p<0.05) and 1.9±1.7% in CGM-Fit group (p<0.05) . Compared to baseline, at 6-month post-randomization, the HbA1c improved by 0.8±1.7% in CGM-alone (p<0.05) and 1.6±1.6% in CGM-Fit group (p<0.05) group) . Between the 4-month and 6-month post-randomization, the HbA1c had increased by 0.8±1.1% in CGM-alone (P <0.05) but only 0.2±0.8% in CGM-fit group (P >0.05) . Overall, 42.4% of subjects had an increase and 39.4% a decrease in diabetes medication when reviewed by the diabetes nurse educator.

In summary, the use of sequential CGM (for 6 weeks) with DM counselling and dietary advice improved HbA1c significantly by a mean of 1.7%. However, this does not appear sustainable at 6 months of follow up. The use of an exercise tracker might be helpful to sustain the improvement in glycaemic control. The use of CGM can guide management in titrating diabetes medication to improve glycaemia.


C.Khoo: None. K.Htike: None. Y.Dan: None.


NUHS AHS Mission Fund

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at