--- title: "Glucose monitor-driven virtual diabetes clinic in type 2 DM | Sutter Health" description: "Onduo virtual diabetes clinic provides support in T2D between office visits with access to endocrinologists and advanced diabetes technology." url: "https://www.sutterhealth.org/research/publications/glucose-monitor-driven-virtual-diabetes-clinic-in-type-2-dm-1055312791" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Glucose monitor-driven virtual diabetes clinic in type 2 DM # Glycemic outcomes in adults with type 2 diabetes participating in a continuous glucose monitor-driven virtual diabetes clinic: prospective trial. Majithia AR, Kusiak CM, Armento Lee A, Colangelo FR, Romanelli RJ, Robertson S, Miller DP, Erani DM, Layne JE, Dixon RF, & Zisser H. _J Med Internet Res. 22(8):e21778. doi: 10.2196/21778._ 2020-08-28 ## Abstract ****Background:**** The Onduo virtual diabetes clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote personalized lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices for intermittent use. ****Objective:**** This prospective single-arm study evaluated glycemic outcomes associated with participation in the Onduo VDC for 4 months. ****Methods:**** Adults aged ≥18 years with T2D and a baseline glycated hemoglobin (HbA1c) of ≥8% to ≤12% were enrolled from 2 primary care centers from February 2019 to October 2019. Participants were asked to engage at ≥1 time per week with their care team and to participate in a telemedicine consultation with a clinic endocrinologist for diabetes medication review. Participants were asked to use a RT-CGM device and wear six 10-day sensors (total 60 days of sensor wear) intermittently over the course of 4 months. The primary outcome was change in HbA1c at 4 months from baseline. Other endpoints included change in weight and in RT-CGM glycemic metrics, including percent time <70, 70-180, 181-250, and >250 mg/dL. Changes in blood pressure and serum lipids at 4 months were also evaluated. ****Results:**** Participants (n=55) were 57.3 (SD 11.6) years of age, body mass index 33.7 (SD 7.2), and 40% (22/55) female. HbA1c decreased significantly by 1.6% (SD 1%; P<.001). When stratified by baseline HbA1c of 8.0% to 9.0% (n=36) and >9.0% (n=19), HbA1c decreased by 1.2% (SD 0.6%; P<.001) and 2.4% (SD 1.3%; P<.001), respectively. Continuous glucose monitoring-measured (n=43) percent time in range (TIR) 70-180 mg/dL increased by 10.2% (SD 20.5%; P=.002), from 65.4% (SD 23.2%) to 75.5% (SD 22.7%), which was equivalent to a mean increase of 2.4 hours TIR per day. Percent time 181-250 mg/dL and >250 mg/dL decreased by 7.2% (SD 15.4; P=.005) and 3.0% (SD 9.4; P=.01), respectively. There was no change in percent time <70 mg/dL. Mean weight decreased by 9.0 lb (SD 10.4; P<.001). Significant improvements were also observed in systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglycerides (P=.04 to P=<.001). ****Conclusions:**** Participants in the Onduo VDC experienced significant improvement in HbA1c, increased TIR, decreased time in hyperglycemia, and no increase in hypoglycemia at 4 months. Improvements in other metabolic health parameters including weight and blood pressure were also observed. In conclusion, the Onduo VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialty care and advanced diabetes technology including RT-CGM. [PubMed abstract](https://pubmed.ncbi.nlm.nih.gov/32856597/) ## Research topics - [Diabetes Type 2](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes+Type+2%5C%22%22) - [Diabetes, Insulin Resistance and Metabolic Syndrome](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%5C%22%22) - [Disease Management](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Disease+Management%5C%22%22) - [Endocrinology and Metabolism](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Endocrinology+and+Metabolism%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [CM-SHARE: Development, integration, and adoption of an electronic health record-linked digital health solution to support care for diabetes in primary care.](https://www.sutterhealth.org/research/publications/ehr-linked-app-to-support-diabetes-care-in-primary-care-1055312811) Jones JB, Liang S, Husby HM, Delatorre-Reimer JK, Mosser CA, Hudnut AG, Knobel K, MacDonald K, Yan XS. Clin Diabetes. 37(4):338-346. doi: 10.2337/cd18-0057. 2019 Oct 01 - Publication ### [Value of primary care diabetes management: long-term cost impacts.](https://www.sutterhealth.org/research/publications/primary-care-diabetes-management-long-term-cost-impacts-1055312665) Maeng DD, Yan X, Graf TR, Steele GD Jr. Am J Manag Care. 22(3):e88-94. 2016 Mar 01 - Publication ### [Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EMPOWER-D), a randomized controlled trial.](https://www.sutterhealth.org/research/publications/online-disease-management-of-diabetes-1055312685) Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP, Hui SL, Hyde SM, Klieman LH, Mitchell CJ, Perkins AJ, Qureshi LS, Waltimyer TA, Winters LJ, Young CY. J Am Med Inform Assoc. 20(3):526-34. doi: 10.1136/amiajnl-2012-001263. Epub 2012 Nov 20. 2013 May 01 - Publication ### [Glucose normalization and outcomes in patients with acute myocardial infarction.](https://www.sutterhealth.org/research/publications/glucose-outcomes-in-ami-pts-1055312974) Kosiborod M, Inzucchi SE, Krumholz HM, Masoudi FA, Goyal A, Xiao L, Jones PG, Fiske S, Spertus JA. Arch Intern Med. 169(5):438-46. doi: 10.1001/archinternmed.2008.593. 2009 Mar 09 - Publication ### [Baseline obesity status modifies effectiveness of adapted diabetes prevention program lifestyle interventions for weight management in primary care.](https://www.sutterhealth.org/research/publications/obesity-status-modifies-dpp-program-for-wt-mgmt-1055312603) Azar KM, Xiao L, Ma J. Biomed Res Int. 2013:191209. doi: 10.1155/2013/191209. Epub 2013 Dec 4. 2013 Dec 04 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/glucose-monitor-driven-virtual-diabetes-clinic-in-type-2-dm-1055312791#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Glucose monitor-driven virtual diabetes clinic in type 2 DM"}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/glucose-monitor-driven-virtual-diabetes-clinic-in-type-2-dm-1055312791#medicalscholarlyarticle","name":"Glycemic outcomes in adults with type 2 diabetes participating in a continuous glucose monitor-driven virtual diabetes clinic: prospective trial.","headline":"Glucose monitor-driven virtual diabetes clinic in type 2 DM","abstract":"Background: The Onduo virtual diabetes clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote personalized lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices for intermittent use. Objective: This prospective single-arm study evaluated glycemic outcomes associated with participation in the Onduo VDC for 4 months. Methods: Adults aged ≥18 years with T2D and a baseline glycated hemoglobin (HbA1c) of ≥8% to ≤12% were enrolled from 2 primary care centers from February 2019 to October 2019. Participants were asked to engage at ≥1 time per week with their care team and to participate in a telemedicine consultation with a clinic endocrinologist for diabetes medication review. Participants were asked to use a RT-CGM device and wear six 10-day sensors (total 60 days of sensor wear) intermittently over the course of 4 months. The primary outcome was change in HbA1c at 4 months from baseline. Other endpoints included change in weight and in RT-CGM glycemic metrics, including percent time \u003c70, 70-180, 181-250, and >250 mg/dL. Changes in blood pressure and serum lipids at 4 months were also evaluated. Results: Participants (n=55) were 57.3 (SD 11.6) years of age, body mass index 33.7 (SD 7.2), and 40% (22/55) female. HbA1c decreased significantly by 1.6% (SD 1%; P\u003c.001). When stratified by baseline HbA1c of 8.0% to 9.0% (n=36) and >9.0% (n=19), HbA1c decreased by 1.2% (SD 0.6%; P\u003c.001) and 2.4% (SD 1.3%; P\u003c.001), respectively. Continuous glucose monitoring-measured (n=43) percent time in range (TIR) 70-180 mg/dL increased by 10.2% (SD 20.5%; P=.002), from 65.4% (SD 23.2%) to 75.5% (SD 22.7%), which was equivalent to a mean increase of 2.4 hours TIR per day. Percent time 181-250 mg/dL and >250 mg/dL decreased by 7.2% (SD 15.4; P=.005) and 3.0% (SD 9.4; P=.01), respectively. There was no change in percent time \u003c70 mg/dL. Mean weight decreased by 9.0 lb (SD 10.4; P\u003c.001). Significant improvements were also observed in systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglycerides (P=.04 to P=\u003c.001). Conclusions: Participants in the Onduo VDC experienced significant improvement in HbA1c, increased TIR, decreased time in hyperglycemia, and no increase in hypoglycemia at 4 months. Improvements in other metabolic health parameters including weight and blood pressure were also observed. In conclusion, the Onduo VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialty care and advanced diabetes technology including RT-CGM.","description":"Onduo virtual diabetes clinic provides support in T2D between office visits with access to endocrinologists and advanced diabetes technology.","keywords":["Diabetes Type 2","Diabetes, Insulin Resistance and Metabolic Syndrome","Disease Management","Endocrinology and Metabolism"],"datePublished":"2020-08-28","url":"https://www.sutterhealth.org/research/publications/glucose-monitor-driven-virtual-diabetes-clinic-in-type-2-dm-1055312791","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"PMID","value":"32856597"},{"@type":"PropertyValue","propertyID":"DOI","value":"10.2196/21778"}],"sameAs":["https://pubmed.ncbi.nlm.nih.gov/32856597/","https://doi.org/10.2196/21778"],"isPartOf":{"@type":"Periodical","name":"J Med Internet Res"},"author":[{"@type":"Person","name":"Majithia AR"},{"@type":"Person","name":"Kusiak CM"},{"@type":"Person","name":"Armento Lee A"},{"@type":"Person","name":"Colangelo FR"},{"@type":"Person","name":"Romanelli RJ"},{"@type":"Person","name":"Robertson S"},{"@type":"Person","name":"Miller DP"},{"@type":"Person","name":"Erani DM"},{"@type":"Person","name":"Layne JE"},{"@type":"Person","name":"Dixon RF"},{"@type":"Person","name":"Zisser H"}],"about":[{"@type":"DefinedTerm","name":"Diabetes Type 2","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Diabetes+Type+2%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Diabetes, Insulin Resistance and Metabolic Syndrome","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Diabetes%2C+Insulin+Resistance+and+Metabolic+Syndrome%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Disease Management","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Disease+Management%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Endocrinology and Metabolism","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Endocrinology+and+Metabolism%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/glucose-monitor-driven-virtual-diabetes-clinic-in-type-2-dm-1055312791","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/glucose-monitor-driven-virtual-diabetes-clinic-in-type-2-dm-1055312791#breadcrumblist"}}} ```