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Remote Glucose Monitoring Engagement and Glycemic Control in Type 2 Diabetes and Prediabetes: Retrospective Cohort
Yong Huang1, Nitish Nagesh1, Ajan Subramanian1
1Department of Computer Science, Donald Bren School of Information and Computer Sciences, University of California, Irvine, 3211 Donald Bren Hall, Irvine, US.
JMIR Formative Research
|July 30, 2026
Summary
Increased engagement in remote glucose monitoring programs causally improves glycemic control in adults with type 2 diabetes and prediabetes. Higher monitoring frequency significantly reduces hemoglobin A1c (HbA1c) levels, supporting scalable digital health strategies.
Area of Science:
- Endocrinology and Metabolism
- Digital Health
- Public Health
Background:
- Suboptimal glycemic control affects millions with type 2 diabetes and prediabetes.
- Remote glucose monitoring shows promise but real-world causal evidence on engagement is limited.
Purpose of the Study:
- To estimate the causal dose-response relationship between patient engagement (weekly glucose monitoring frequency) and glycemic control (HbA1c).
- To evaluate adults in a primary care-integrated remote monitoring program.
Main Methods:
- Retrospective cohort study of 1,436 adults with diabetes/prediabetes.
- Used marginal structural models (MSMs) with inverse probability weighting (IPW) to assess causal effects.
- Defined engagement as mean weekly glucose monitoring frequency over 6 months.
Main Results:
- Higher engagement tiers showed progressively greater HbA1c reductions.
- Each additional weekly measurement associated with a 0.05 percentage point greater HbA1c reduction.
- High engagement patients with baseline HbA1c ≥9.0% achieved a mean reduction of 3.12 percentage points.
Conclusions:
- Higher engagement in digitally enabled remote monitoring causally linked to greater HbA1c reductions.
- Supports scalable remote patient monitoring strategies that foster sustained patient engagement.
- Effective approach to improving glycemic control and reducing diabetes burden.
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