Association Between Real-Time Continuous Glucose Monitoring Sensor Active Time and Glycemic Metrics in Patients With Diabetes: A Real-World Setting Analysis

Background: Consistent use of continuous glucose monitoring (CGM) systems improves glycemic control compared with occasional use. We aimed to assess the association between the percent time sensor was active and glycemic metrics, among patients with diabetes using the FreeStyle Libre 2 Plus CGM System. Methods: De-identified CGM data from 12 162 readers of patients with diabetes in Saudi Arabia, between January 2023 and September 2024, were analyzed. Readings were grouped into five sensor usage quintiles. For each quintile, average glycemic metrics were summarized, including mean glucose, glucose management indicator (GMI), time in range (TIR), time below range (TBR), time above range (TAR), and glycemia risk index (GRI). The Jonckheere-Terpstra trend test was used to assess monotonic trends between sensor usage time and glycemic metrics. Results: As sensor use increased, there were significant decreases in GRI ( Std. J-T = −29.672), average blood glucose ( Std. J-T = −23.985), GMI (Std. J-T = −23.949), and TAR ( Std. J-T = −21.964). Time below range showed a different pattern, with an initial increase followed by a decline from the third quantile as sensor usage increased ( Std. J-T = −4.903). Time in range increased significantly with greater sensor usage ( Std. J-T = 25.428; all P -values <.001). Conclusion: In real-world settings, higher CGM use was associated with better glycemic outcomes, including lower GRI, lower average blood glucose, lower GMI, lower TAR, lower TBR, and higher TIR. Future studies should examine factors influencing sensor use to inform strategies that promote effective CGM adoption.