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The AH-HA! Project: Transforming Group Diabetes Self-Management Education Through the Addition of Flash Glucose Monitoring
Abstract
Background: The majority of individuals referred to diabetes self-management education and support (DSMES) programs do not access this resource. Of those who do, attrition is high, with anecdotal reports pointing to the didactic and impersonal nature of these programs contributing to low utilization and completion rates. In an effort to develop a more engaging form of DSMES for adults with type 2 diabetes (T2D), we constructed a nondidactic “discovery learning”-based DSMES program centered on real-time flash glucose monitoring (FGM). Methods: In this single-arm pilot study, 35 adults with T2D duration 1–5 years, ages 21–75 years, not using insulin and HbA1c ≥8.0% were introduced to FGM and participated in five weekly group sessions. DSMES content was personalized, emerging from the concerns and questions arising from participants' FGM discoveries. The primary outcome was glycemic change as assessed by blinded FGM at baseline and month 3. Secondary outcomes included psychosocial and behavioral measures. Results: There was a significant gain in percentage time in range (% TIR) 70–180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop-in percentage time above range (TAR) >180 mg/dL from 44% to 25% ( P s = 0.01). Overall well-being rose significantly ( P = 0.04), whereas diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating ( P < 0.001) and physical activity, although the latter did not reach statistical significance. Conclusions: These findings support a new approach to DSMES, a method that integrates FGM with a highly interactive and engaging patient-driven “discovery learning” approach to education.
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In Polonsky et al. 2023, a single-arm pilot of 35 non-insulin-using adults in a DSME programme found that 3 months after isCGM introduction, TIR increased from 55% to 74% (p = 0.01) and TAR decreased from 44% to 25% (p = 0.01).
“Polonsky and colleagues conducted a single‐arm pilot study of 35 non‐insulin‐using adults as part of a ‘discovery learning’‐based diabetes self‐management education (DSME) programme 15 and found that 3 months after the introduction of isCGM, TIR increased significantly from 55% to 74% (p = 0.01) with a parallel decrease in TAR from 44% to 25% (p = 0.01).”
Citations
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Cited by
Sorted by citations
Expanding the Role of Continuous Glucose Monitoring in Modern Diabetes Care Beyond Type 1 Disease
Klupa, T., Czupryniak, L., Dzida, G. J., Fichna, P., Jarosz-Chobot, P. A., Gumprecht, J., Myśliwiec, M., Szadkowska, A., Bomba-Opon, D. A., Czajkowski, K., et al. (2023) · Diabetes Therapy · doi:10.1007/s13300-023-01431-3 · Cited by 89
“improved adherence to dietary plans, improved healthy eating, and physical activity [73, 101].”
BackgroundRosenfeld, R. M., Grega, M. L., Karlsen, M. C., Dabrh, A. M. A., Aurora, R. N., Bonnet, J. P., Donnell, L., Fitzpatrick, S. L., Frates, E. P., Joy, E. A., et al. (2025) · American Journal of Lifestyle Medicine · doi:10.1177/15598276251325488 · Cited by 31
Clark, T. L., Polonsky, W. H., & Soriano, E. C. (2024) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0612 · Cited by 41
Self-citationAronson, R., Abitbol, A., Bajaj, H. S., Cheng, A. Y. Y., Christopoulos, S., Harris, S. B., Jain, A. B., & Goldenberg, R. M. (2025) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.70008 · Cited by 33
Conti, M., Massari, G., Meneghini, E., Pasquino, B., Agosti, B., Chinotti, F., Pintaudi, B., Girelli, A., & Bertuzzi, F. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13030642 · Cited by 21
“There was a significant gain in % TIR and a parallel drop in % TAR, together with an overall increase in well-being, and an improvement in healthy eating [21].”
BackgroundBergenstal, R. M. (2023) · Diabetes Spectrum · doi:10.2337/dsi23-0005 · Cited by 19
Bannuru, R. R., Bellini, N. J., Bergenstal, R. M., Beverly, E. A., Christofides, E. A., Cox, D. J., Ehrhardt, N. M., Fazioli, K., Fischl, A. H., Kerr, D. E., et al. (2025) · Journal of Diabetes Science and Technology · doi:10.1177/19322968251384318 · Cited by 17
“54 Results from subgroup analyses also showed trends toward greater glycemic benefits among those with higher baseline HbA1c levels.”
Is Continuous Glucose Monitoring a Tool, an Intervention, or Both?
Wright, E. E., & Subramanian, S. (2023) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2023.0025 · Cited by 10
“Unfortunately, despite a growing body of evidence demonstrating the benefits of CGM in T2D patients treated with non-intensive therapies, 35–44 coverage for noninsulin-treated T2D is restricted or denied.”
Peng, M., Shen, P., & Kim, K. J. (2026) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-025-01870-0 · Cited by 7
“Among these, 3 studies utilized the International Physical Activity Questionnaire (IPAQ) [33, 42, 44], 2 applied the Self-Efficacy for Exercise Behavior Scale (SEBS) [30, 32], and 8 studies involved participant-recorded exercise logs [16, 31, 43, 46, 49–52].”
Engineering Glucose‐Responsive Insulin Granules with High‐Payload for Long‐Acting Glycemic Control
Chen, D.-Z., Yang, L., Ni, S., Jin, C., Xu, C., Zan, X.-J., Wang, Y., & Zhu, H. (2025) · Advances in Materials · doi:10.1002/adma.202501344 · Cited by 6
Willis, H. J., Henderson, M. S. G., Zibley, L. J., & JaKa, M. M. (2024) · JMIR Diabetes · doi:10.2196/67636 · Cited by 8
Almehthel, M. S., Al-Saeed, A., Alsabaan, F., Almalki, F., ZARIF, H. A., Al-Zubaidi, L., Al‐Sofiani, M. E., Abdulaal, O., Argan, R. A., Sifri, S. A., et al. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2025.1738398 · Cited by 2
Growing Up: A 50-Year Journey From Compliance to Collaboration
Funnell, M. (2023) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106231169695 · Cited by 3
Self-citationRomero-Castillo, R., Pabón-Carrasco, M., Kaknani-Uttumchandani, S., & Ponce-Blandón, J. A. (2025) · Healthcare · doi:10.3390/healthcare13243197 · Cited by 2
“Based on previous diabetes self-management education studies reporting medium effects of TIR, a Cohen’s d = 0.50 was assumed, with α = 0.05, power (1 − β ) = 0.80, and an anticipated attrition rate of 20% [24].”
InfluentialBerthoumieux, A., Naqvi, J. B., Zion, S. R., Napoleone, J. M., McGuill, A., Cerrada, C. J., Lee, H. J., Dunn, T. C., Kerr, D. E., Jasik, C. B., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/78321 · Cited by 1
“However, previous research studies evaluating DSMES programs integrated with CGM have predominantly focused on in-person programs and short-term intermittent use of CGM for less than 8 weeks [13-16].”
Brown, J. V. E., Matthias, O., Hendon, J., Ajjan, R., Siddiqi, N., Kellar, I., & Coventry, P. A. (2026) · Frontiers in Health Services · doi:10.3389/frhs.2026.1807689
“This real-time visual reinforcement can help build self-efficacy and support lifestyle changes in ways that traditional blood glucose monitoring fails to provide, given the sporadic and limited nature of the data (26).”
Polonsky, W. H., Clark, T. L., Soriano, E. C., Edgington, A., Bennett, C., Fox, A. E., & Grace, T. (2026) · Endocrinology, Diabetes & Metabolism · doi:10.1002/edm2.70236
“…to enhance the benefits of CGM use among people with T2D, these findings would suggest that methods to support individuals' sense of self-discovery, helping users to see how one's own self-management actions and personal experiments can influence glycemia, may be particularly useful [21, 22].”
Self-citationWu, C. C., Wu, K. C., & Reddy, S. (2025) · Diabetes Technology and Obesity Medicine · doi:10.1089/dtom.2025.0005
Metadata
- Authors
- Polonsky, W. H., Fortmann, A. L., Soriano, E. C., Guzman, S. J., & Funnell, M. M.
- Affiliations
- University of California San Diego (US)
- Scripps Health (US)
- Behavioral Diabetes Institute, San Diego, California, USA.
- University of Michigan (US)
- Corresponding author
- Polonsky, William H.
- Venue
- Diabetes Technology & Therapeutics
- Publisher
- SAGE Publications
- Published
- 2023-02-28
- Volume
- 25
- Issue
- 3
- Pages
- 194-200
- ISSN
- 1520-9156 (ISSN-L)
- 1557-8593
- OpenAlex
- W4309516365
- Cited by
- 20
- References
- 0
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 4 · 2023: 5
- FWCI
- 2.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Technology & Therapeutics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- diabetes self-management education, flash glucose monitoring, type 2 diabetes, group education, discovery learning, time in range, glycemic control, diabetes distress, patient engagement, personalized education, healthy eating, physical activity
- MeSH terms
- Self-Management, Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Middle Aged, Pilot Projects, Blood Glucose Self-Monitoring, Young Adult
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