CGM tied to lower mortality in insulin-treated type 2 diabetes

Clinical takeaway: Consider CGM not only as a tool for improving glycemic management, but also as a technology that may be associated with better long-term cardiovascular outcomes in patients with type 2 diabetes treated with basal insulin. These findings are observational and require confirmation in prospective studies.

Continuous glucose monitoring (CGM) is known to improve glucose control and reduce hypoglycemia, but its impact on major clinical outcomes in insulin-treated type 2 diabetes has remained less certain. New data presented at the EASD 2026 Annual Meeting, and not yet peer reviewed, suggest CGM use may be linked to substantially lower risks of death and cardiovascular events in this population.

In a target trial emulation study using electronic health record data from more than 140 million US patients, investigators compared 13,935 adults with type 2 diabetes who initiated CGM with an equal number of matched nonusers receiving basal insulin therapy. Participants were matched across 29 baseline characteristics, including age, diabetes duration, HbA1c, comorbidities, medication use, and healthcare utilization.

After 12 months, CGM users were 44% less likely to die from any cause than nonusers, with mortality rates of 1.16% versus 2.09%. At 24 months, mortality remained 35% lower among CGM users (2.12% vs 3.26%).

CGM use was also associated with fewer cardiovascular complications. The risk of a first major macrovascular event, including MI, heart failure, stroke, TIA, or peripheral artery disease, was 26% lower at 12 months and 24% lower at 24 months. Recurrent macrovascular events were reduced by roughly one-third at both time points. Heart failure hospitalizations were about half as common among CGM users, declining by 54% at 12 months and 47% at 24 months.

The findings remained consistent across multiple sensitivity analyses, including those that excluded the COVID-19 period and early deaths. However, investigators noted that the observational design cannot establish causality and that unmeasured confounding may have influenced results.

“Our study suggests that CGM can make a real difference to the long-term health of people living with type 2 diabetes who require insulin and may help reduce the risk of early death,” said lead investigator Jochen Seufert, MD, of the University Hospital of Freiburg, Germany.

Source: Seufert J, et al. (2026 Sep 28) 62nd EASD Annual Meeting, abstract LBA 21. Association of continuous glucose monitoring on all-cause mortality and macrovascular complications in adults with type 2 diabetes on basal insulin therapy in the U.S.: a target trial emulation