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

Abstract

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.