SAT-643 - Meals, Monitors, and Meetings: A Hybrid CGM and Nutrition Program for Adults with Uncontrolled Type 2 Diabetes

Background: Adults with type 2 diabetes mellitus (T2DM) and elevated hemoglobin A1c (HbA1c) often face food insecurity, limited health literacy, and complex treatment regimens that contribute to persistent hyperglycemia and complications [1]. Medically tailored meal (MTM) programs that provide diabetes-specific prepared meals have been linked to improved diet quality, better self-management, and reduced health care utilization, with emerging evidence for improved glycemic control [2]. Continuous glucose monitoring (CGM) has independently been shown to reduce HbA1c, increase time in range, and lower the occurrence of hyperglycemia in adults with insulin-treated T2DM [3]. We evaluated a hybrid program integrating CGM, MTM, and group-based nutrition education for adults with uncontrolled T2DM.

Methods: We conducted a 13-week program for adults with T2DM and baseline HbA1c greater than 7%. Participants initiated CGM at enrollment, received two MTM per day for the first four weeks, and then transitioned to self-prepared meals for eight weeks, supported by dietitian-led virtual group visits every two weeks. Primary outcome was change in laboratory HbA1c from baseline to program completion; secondary outcomes included weight and longitudinal CGM metrics (estimated HbA1c, average glucose, time in range, glucose variability, and hypoglycemia).

Results: Fifteen participants enrolled; 62% had a diabetes duration ≥6 years, and all but one had a baseline HbA1c above 7% (one had HbA1c of 6.8%). Ten of fifteen participants completed the program and provided end of program laboratory data. Mean laboratory HbA1c decreased from 9.7% at baseline to 7.5% at completion (p = 0.0077). Mean weight changed from 206.4 to 205.8 pounds (p = 0.7579). CGM derived estimates of HbA1c showed a nonsignificant trend toward improvement (p = 0.0918). Across program intervals, average glucose progressively declined, time in range increased, glucose variability remained stable, and time spent in hypoglycemia stayed low. During the program, most participants had diabetes medication changes; a GLP-1 receptor agonist was added for three participants and basal insulin for two participants.

Conclusions: In this small cohort of adults with uncontrolled T2DM, a multicomponent program integrating CGM, MTM, and group-based nutrition education was associated with clinically meaningful reductions in laboratory HbA1c and improved day-to-day CGM profiles without excess hypoglycemia. This supports broader testing of comprehensive food and technology-based interventions that address social and behavioral determinants of diabetes control.
References
1. Shaheen M et al. Clin Nutr ESPEN. 2021;46:336–342.
2. Clark JM et al. J Gen Intern Med. 2025;40:1711–1719.
3. Martens T et al. JAMA. 2021;325:2262–2272.

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