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Landmark trial shows continuous glucose monitors cut A1c in type 2 diabetes patients not on insulin

Landmark trial shows continuous glucose monitors cut A1c in type 2 diabetes patients not on insulin

New Capabilities

New England Journal of Medicine study: CGM users spent five more hours a day in healthy blood sugar range

October 14th, 2026: CONNECT study published in New England Journal of Medicine

Overview

Updated Oct 18

For millions of Americans with type 2 diabetes who don't take insulin, checking blood sugar has meant fingerstick tests a few times a day. A 26-week trial published in the New England Journal of Medicine in October showed that continuous glucose monitors (CGMs), small sensors worn on the arm that stream glucose readings, kept patients in a healthy blood sugar range for about five extra hours each day.

CGM users cut their A1c (average blood sugar over three months) by 1.6 percentage points from a baseline of 8.8%, 0.9 points more than routine care. The American Diabetes Association now recommends CGM for type 2 patients on any treatment regimen, and a separate real-world study of 25,648 adults linked long-term use to lower A1c and healthier kidneys. Dexcom expects a Medicare coverage decision before the end of 2026; expanding coverage to non-insulin patients would double its covered population to about 30 million.

Why it matters

If insurers expand coverage, millions of type 2 diabetes patients who don't take insulin could get daily glucose tracking that cuts A1c by a full percentage point.

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Key Indicators

97%
Median device wear time (26 weeks)
Participants wore the sensor most days during the trial.

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People Involved

TO
Tamara Oser
Lead author of the CONNECT trial
Lead researcher presenting findings at ADA 2026 Scientific Sessions
PM
Priyanka Mahapatra
Physician researcher at Kaiser Permanente who studies high-risk diabetes patients
Advocated for expanding CGM access to non-insulin patients at high cardiovascular risk

Organizations Involved

DexCom
DexCom
Medical device manufacturer
Manufacturer of the Dexcom G7 CGM used in the CONNECT trial; expects a CMS coverage decision before end of 2026 and implementation in mid-2027

DexCom makes continuous glucose monitoring systems, including the Dexcom G7 sensor tested in the CONNECT trial.
American Diabetes Association
American Diabetes Association
Professional medical association
Updated its Standards of Care in June 2026 to recommend CGM for adults with type 2 diabetes on any treatment regimen in which it helps manage the condition

The American Diabetes Association sets clinical guidelines for diabetes care in the U.S., including when CGMs should be prescribed.

Timeline

2026 October 2026

6 events Latest: October 14th, 2026 · 4 weeks ago
Tap a bar to jump to that date

  1. CONNECT study published in New England Journal of Medicine

    Latest Publication

    The 26-week randomized controlled trial of 283 adults across 22 U.S. primary care sites showed CGM users spent ~5 more hours daily in target range and cut A1c by 0.9 points more than routine care.

  2. Real-world study links long-term CGM use to better glucose and kidney outcomes

    Research

    A comparative effectiveness study of 25,648 adults with type 2 diabetes found long-term real-time CGM use was associated with a roughly 0.8-percentage point lower A1c after 36 months and reduced urinary albumin-creatinine ratio, an early marker of kidney damage.

  3. ADA updates Standards of Care to recommend CGM for type 2 diabetes

    Guideline update

    The American Diabetes Association updated its standards to recommend CGM for adults with type 2 diabetes on any treatment regimen in which it helps manage the condition, according to the Cleveland Clinic Journal of Medicine.

  4. CONNECT trial findings presented at ADA Scientific Sessions

    Conference presentation

    Researchers first presented the trial results at the American Diabetes Association's 2026 Scientific Sessions, where they generated attention from diabetes clinicians.

  5. Kaiser Permanente study links CGM use to kidney benefits

    Research

    Patients with poorly controlled type 2 diabetes who used CGMs had sustained A1c reductions over 3 years and less protein in urine, an early sign of kidney health.

  6. Meta-analysis of 25 randomized trials finds CGM improves glycemic control

    Research

    A systematic review of 25 randomized controlled trials in adults with type 2 diabetes on non-intensive or non-insulin therapy found CGM reduced HbA1c by 0.34 percentage points on average and increased time in range by 7.85 percentage points, with benefits most pronounced in non-insulin-treated populations.

Scenarios

1

ADA upgrades CGM recommendation to Level A for non-insulin type 2 diabetes

Likely Resolves by Jan 31, 2027

Discussed by: Diabetes researchers, primary care physicians, and the American Diabetes Association

The American Diabetes Association's Standards of Care are updated annually, typically in January. The CONNECT trial's publication in the NEJM provides the rigorous multicenter evidence the ADA previously lacked for non-insulin patients. An upgrade to Level A evidence would signal that CGMs are now a standard treatment option for this group, encouraging more primary care doctors to prescribe them.

2

CMS and private insurers expand CGM coverage to all type 2 diabetes patients

Possible Resolves by Q2 2027

Discussed by: Centers for Medicare & Medicaid Services, private insurers, DexCom investor communications

The Centers for Medicare & Medicaid Services (CMS) currently covers CGMs primarily for insulin-treated patients. The CONNECT results add to a growing evidence base that could prompt CMS to expand coverage to non-insulin type 2 diabetes patients, a change private insurers often follow. DexCom's investor materials and the prevalence of type 2 diabetes make this a high-stakes coverage decision.

3

Adoption stays limited; guideline changes lag behind evidence

Possible Resolves by Q2 2027

Discussed by: ACP reviewers who published a meta-analysis showing modest benefit

A 2026 American College of Physicians review of randomized trials found CGM use was linked to only about a 0.3% HbA1c reduction on average and limited evidence for patients not on glucose-lowering therapy. If this more cautious interpretation prevails, insurers and guideline bodies may hold off on broad coverage expansion, keeping CGMs a niche tool despite the CONNECT results.

Historical Context

2 moments from history that rhyme with this story — and how they unfolded.

1983-1993

Diabetes Control and Complications Trial (1993)

The NIH-sponsored DCCT followed 1,441 people with type 1 diabetes for up to a decade, proving that intensive glucose control dramatically reduced eye, kidney, and nerve complications. It transformed type 1 diabetes care from a 'just survive' approach to aggressive monitoring and insulin adjustment.

Then

Intensive insulin therapy and frequent blood sugar monitoring became the standard of care for type 1 diabetes.

Now

Established A1c as the gold-standard measure of diabetes control and justified the cost of monitoring technology.

Why this matters now

Like DCCT, the CONNECT trial uses rigorous randomized evidence to shift monitoring technology from optional to standard — this time for the far larger type 2 population.

1980s

Home blood glucose meters (1980s)

Portable fingerstick glucose meters became available and affordable in the 1980s, letting patients check blood sugar at home instead of relying on urine tests or clinic visits. Adoption was slow initially due to cost and questions about whether the data changed outcomes.

Then

Self-monitoring of blood glucose became routine for insulin users and eventually for many type 2 patients.

Now

Insurance coverage expanded over decades; meters became a standard diabetes tool rather than a luxury.

Why this matters now

CGMs are the next generation of this story: the technology exists and works, but coverage and prescribing practices lag behind the evidence.

Sources

(14)
+8
PR Newswire DexCom Investor Relations Centers for Disease Control and Prevention ACP Diabetes Monthly Kaiser Permanente Division of Research JAMA Network Open American Diabetes Association Managed Care CGM Harvard Health Diabetes.co.uk Cleveland Clinic Journal of Medicine MedTech Dive Journal of Diabetes Science and Technology JAMA Network Open