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Cited by 1Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes Management and Education

The DOI matches its Crossref record; 20 of the 20 references it cites were found in a registry or an index; 12 of the 17 sources its claims cite were checked for support.

Sequential use of continuous glucose monitoring, with or without exercise trackers, significantly improves glycemic control in patients with type 2 diabetes

Open access
Lahiri, Anushka, Lim, Suan Tee, Kyu, Htike, Dan, Yock Young, Khoo, Chin Meng·2025·Diabetology & Metabolic Syndrome
DOI 10.1186/s13098-025-02035-6PMC PMC12764008

Published version of a preprint

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Abstract

AIMS: Continuous glucose monitoring systems (CGM) and exercise trackers offer real-time feedback on the effects of lifestyle intervention on blood glucose. This randomized controlled trial aimed to examine whether an additional exercise tracker (Fitbit) would improve glycemic control, in combination with sequential CGM (FreeStyle Libre), in middle-aged patients with Type 2 Diabetes. METHODS: This 6-month prospective study included 158 patients, of whom 138 participants completed the protocol, with a median age of 58 (54, 62) years and HbA1c of 9.7% (8.8, 10.4). There were 69.6% participants on insulin therapy. Participants were randomly assigned to one of two groups: a group wearing a CGM alone (CGM, n = 73) or a group wearing both a CGM and a Fitbit INSPIRE HR (CGM-Fit, n = 65). All participants wore three sequential CGM (2 weekly for 6 weeks), coupled with diabetes education and diet counselling. RESULTS: Both groups demonstrated sufficient CGM data capture at each two weeks (89.8%, 90.8%, 92%), with an average wear time of 14 days and 6-7 scans per day. Overall, time-in-range increased (61%, 67%, 71%; p < 0.01) and time-above-range decreased (35%, 27%, 25%; p < 0.01). HbA1c reduced significantly (p < 0.0001) between baseline and 3 months by 1.5% in both groups, independent of weight changes. However, between 3 and 6 months, the CGM group experienced a rise in HbA1c of 0.7% (p < 0.0001) compared (p < 0.05) to the 0.4% rise (p < 0.0001) in the CGM-fit group. The CGM-Fit group maintained their physical activity levels, whereas the CGM group experienced a significant reduction (p < 0.01) in physical activity. CONCLUSIONS: The use of sequential CGM, guided by Diabetes counselling and dietary advice, significantly improved HbA1c. Using an exercise tracker may help sustain physical activity and glycemic control.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In this 6-month randomized trial of 138 completers with suboptimally controlled type 2 diabetes, sequential CGM plus education/diet counselling reduced HbA1c by 1.5% at 3 months, but HbA1c rebounded by 6 months. Adding a Fitbit exercise tracker did not change the initial HbA1c drop but was associated with less rebound (0.4% vs 0.7%) and maintained physical activity.

Key findings

  • HbA1c fell significantly by 1.5% from baseline to 3 months in both groups (p < 0.0001), independent of weight changes; between 3 and 6 months, HbA1c rose 0.7% in the CGM group vs 0.4% in the CGM-Fit group (between-group p < 0.05; both within-group p < 0.0001).
  • At 6 months, 73% of participants had decreased HbA1c from baseline, less than 1% remained unchanged, and 26.4% experienced an increase.
  • CGM metrics improved: time-in-range increased (61%, 67%, 71%; p < 0.01), time-above-range decreased (35%, 27%, 25%; p < 0.01), average blood glucose decreased by 1.2 mmol/l (p < 0.0001), Glucose Management Indicator fell from 7.3% to 6.9% (p < 0.05), and glycemic variability was reduced by approximately 5%.
  • The CGM-Fit group maintained physical activity, whereas the CGM group reduced activity by −540 MET minutes/week (p < 0.01).

Methods

  • Six-month prospective randomized controlled trial at the Diabetes Clinic, National University Hospital, Singapore. The abstract states 158 patients were included and 138 completed; the Results state 165 were recruited and 138 completed, with final groups of CGM alone (n = 73) and CGM plus Fitbit Inspire HR (CGM-Fit, n = 65).
  • All participants wore three consecutive 2-week FreeStyle Libre 2.0 CGMs over 6 weeks, paired with diabetes education and diet counselling; the CGM-Fit group wore the Fitbit for the full 6 months. Primary outcome was change in HbA1c at 3 and 6 months; weight, blood pressure, and physical activity (WHO Global Physical Activity Questionnaire) were also recorded.
  • Analysis used Shapiro-Wilk normality testing, unpaired t-tests or Mann-Whitney U tests, Wilcoxon signed-rank tests for repeated non-parametric data, mixed-effects one-way ANOVA for repeated measures, and GraphPad Prism Version 10.2.0 with p < 0.05.

Limitations

  • Stated: single-center study in Singapore; local cultural and infrastructural healthcare factors may affect generalizability; the study cannot report changes in motivation or patient activation; there was no control group receiving SMBG, periodic CGM, or a single ad hoc CGM; and no group without diabetes education or dietary advice was tested. The authors also note possible Hawthorne effect.
  • Evident from the text: sample-size reporting is internally inconsistent—the abstract says 158 included, the Results say 165 recruited, Table 1 is labeled N = 138 but age and ethnicity counts sum to 158, and Fig. 3 reports CGM n = 82 and CGM-Fitbit n = 76 versus the final analysis groups of 73 and 65.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13098-025-02035-6

Cites

20 of 20 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

12 of 17 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Previous studies examining the use of CGM in patients with T2D over a 6-month period, without midpoint CGM measurements, found only a modest reduction in HbA1c.

    “Similarly, previous studies examining the use of CGM in patients with T2D over a 6-month period, without midpoint CGM measurements, found only a modest reduction in HbA1c [10, 16].”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • cites [10] Kong SY, Cho MK. Effects of continuous glucose monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis. Healthc Basel. 2024;29(5):571. source

      The Results (§3.4; page unavailable) report a small overall reduction in HbA1c with CGM in patients with type 2 diabetes (Hedges’ g = −0.37). The Discussion (§4; page unavailable) discusses studies lasting at least 24 weeks, but does not say that six-month studies without midpoint CGM measurements specifically found only a modest reduction. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [16] Kim JY, Jin S-M, Sim KH, et al. Continuous glucose monitoring with structured education in adults with type 2 diabetes managed by multiple daily insulin injections: a multicentre randomised controlled trial. Diabetologia. 2024;67(7):1223–34. source

      The Study outcomes section describes a 24-week trial in adults with type 2 diabetes, and Table 2 reports HbA1c reductions at week 24. But the claim that it lacked midpoint CGM measurements is not supported: the Change in CGM metrics section reports measurements at week 12, and the Study design and participants section says CGM was used throughout the 24 weeks in both CGM groups. The structured-education group’s HbA1c reduction was 1.00 percentage point, so describing the study’s reductions collectively as only modest also obscures that result (page numbers unavailable). (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    CGM is superior to SMBG in glycemic management, particularly in patients using real-time CGM.

    “In a recent meta-analysis of 11 high-quality studies involving 1425 individuals with T2D, Lu et al. demonstrated that CGM is superior to SMBG in glycemic management, particularly in patients using real-time CGM [18].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [18] Lu JY, Ying Z, Li L, Fu M, Han C, Zhang M. Effects of continuous glucose monitoring on glycaemic control in type 2 diabetes: a systematic review and network meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2023;26(1):362–72. source
  • Premisecitation

    CGM with or without structured education is superior in reducing HbA1c in patients with T2D.

    “Furthermore, Kim et al. [16] demonstrated the superiority of CGM with or without structured education in reducing HbA1c in patients with T2D.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [16] Kim JY, Jin S-M, Sim KH, et al. Continuous glucose monitoring with structured education in adults with type 2 diabetes managed by multiple daily insulin injections: a multicentre randomised controlled trial. Diabetologia. 2024;67(7):1223–34. source

      The Discussion reports that CGM with structured education was superior to both blood glucose monitoring and CGM with conventional education for reducing HbA1c. Table 2 shows HbA1c fell with conventional-education CGM, but its reduction was similar to that with blood glucose monitoring; the paper does not establish superiority without structured education. The trial was also limited to adults with type 2 diabetes using multiple daily insulin injections. Page numbers were not supplied. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
  • Findingown data

    Participants in both groups started at the same baseline levels of physical exercise.

    “Participants in both groups started at the same baseline levels of physical exercise.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Average blood glucose level decreased by 1.2 mmol/l (p < 0.0001).

    “The average blood glucose level decreased by 1.2 mmol/l (p < 0.0001).”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one. 22
  • Probably not a substantial claim. 26

  • It may state two separate claims as one.

    Premisecitation

    Maintaining physical activity can aid in glycemic control, while a decrease in physical activity can contribute to a deterioration in glycemic control.

    “Our findings align with the literature, which demonstrates that maintaining physical activity can aid in glycemic control, while a decrease in physical activity can contribute to a deterioration in glycemic control [13, 17].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [13] Peng P, Zhang N, Huang J, Jiao X, Shen Y. (2023) Effectiveness of wearable activity monitors on metabolic outcomes in patients with type 2 diabetes: a systematic review and meta-analysis. Endocr Pract. 2023;29(5):368–378. source
    • cites [17] Mähs M, Pithan JS, Bergmann I et al. Activity tracker-based intervention to increase physical activity in patients with type 2 diabetes and healthy individuals: study protocol for a randomized controlled trial. Trials. 2022; 30;23(1):617. source

      The Introduction (Background and rationale; page unavailable) reports that physical activity can reduce fasting glucose and HbA1c, supporting the glycemic-control benefit. It also compares higher with lower activity levels, but does not establish that a decrease in an individual's activity over time causes glycemic control to deteriorate. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim.

    Premisecitation

    A crucial element in fostering effective health behavior change is the provision of just-in-time feedback.

    “A crucial element in fostering effective health behavior change is the provision of ‘just-in-time’ feedback [5].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [5] Schembre SM, Liao Y, Robertson MC, et al. Just-in-time feedback in diet and physical activity interventions: systematic review and practical design framework. J Med Internet Res. 2018;22(3):e106. source

  • Probably not a substantial claim.

    Premisecitation

    The study design was based on the premise that immediate feedback and positive outcomes would reinforce healthy behaviors.

    “The study design was based on the premise that immediate feedback and positive outcomes would reinforce healthy behaviors [12].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [12] Del-Valle-Soto C, López-Pimentel JC, Vázquez-Castillo J, Nolazco-Flores JA, Velázquez R, Varela-Aldás J et al. A Comprehensive Review of Behavior Change Techniques in Wearables and IoT: Implications for Health and Well-Being. Sensors [Internet]. 2024;24(8):2429. Available from: https://www.mdpi.com/1424-8220/24/8/2429 source

  • It may state two separate claims as one.

    Premisecitation

    CGM provides continuous data, highlights trends in glycemic excursions, and detects impending hypoglycemia.

    “Unlike traditional self-monitoring methods, CGM provides continuous data, highlights trends in glycemic excursions and detects impending hypoglycemia [6].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Zahedani AD, McLaughlin T, Veluvali A, et al. Digital health application integrating wearable data and behavioral patterns improves metabolic health. NPJ Digit Med. 2023;25(1):216. source

      The Introduction (page not specified) describes real-time feedback about glucose trends and alarm features, while the Discussion (page not specified) says CGM reveals glycemic excursions more readily than older measurement methods. The copy does not say that CGM detects impending hypoglycemia; it reports alarms and reduced hypoglycemia, which do not establish that specific capability. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim.

    Premisecitation

    A recent systematic review by Kong et al. reported an absolute change in HbA1c of up to −0.5% among T2D patients using real-time CGM.

    “A recent systematic review by Kong et al. reported an absolute change in HbA1c of up to −0.5% among T2D patients using real-time CGM [10].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [10] Kong SY, Cho MK. Effects of continuous glucose monitoring on glycemic control in type 2 diabetes: a systematic review and meta-analysis. Healthc Basel. 2024;29(5):571. source

      Results §3.4 reports a significant HbA1c reduction with real-time CGM, supporting the direction of the claim. It gives the overall CGM effect as Hedges’ g = −0.37, a standardized effect size—not an absolute HbA1c change of up to −0.5%. No such percentage-point figure appears in the retrieved passages; page numbers were unavailable. (LLM, conf=0.89)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    CGM has been extensively utilized in patients with Type 1 Diabetes, and emerging evidence supports its potential benefits in managing T2D.

    “While CGM has been extensively utilized in patients with Type 1 Diabetes [7–9], emerging evidence supports its potential benefits in managing T2D.”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [7] Kim JY, Kim S, Kim JH. Current Status of Continuous Glucose Monitoring Use in South Korean Type 1 Diabetes Mellitus Population–Pronounced Age-Related Disparities: Nationwide Cohort Study. Diabetes & Metabolism Journal [Internet]. 2025 Apr 28 [cited 2025 Aug 25]; Available from: https://www.e-dmj.org/journal/view.php?number=2945 source

      The Introduction says CGM is recommended for people with type 1 diabetes, supporting its use in that population. But the Discussion reports that CGM utilization in South Korea remains low, so this study does not establish that it is extensively used. The citation is attached to the type 1 diabetes clause, not the subsequent claim about type 2 diabetes. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [8] Rubelj K, Stipančić G, La Grasta Sabolić L, Požgaj Šepec M. Continuous glucose monitoring and type 1 diabetes mellitus control in child, adolescent and young adult population - arguments for its use and effects. Acta Clin Croat. 2021;60(4):609–16. source

      The Introduction describes CGM as a validated method for type 1 diabetes, supporting its established use. But it also says clinical use is “still quite modest” and reports use by 20%–30% of children with type 1 diabetes, so “extensively utilized” overstates this source. The T2D clause follows the citation and is not attributed to it. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [9] Teo E, Hassan N, Tam W, Koh S. Effectiveness of continuous glucose monitoring in maintaining glycaemic control among people with type 1 diabetes mellitus: a systematic review of randomised controlled trials and meta-analysis. Diabetologia. 2022;65(4):604–19. source

  • It may state two separate claims as one.

    Findingown data

    The CGM-Fit group maintained their physical activity levels, whereas the CGM group experienced a significant reduction (p < 0.01) in physical activity.

    “The CGM-Fit group maintained their physical activity levels, whereas the CGM group experienced a significant reduction (p < 0.01) in physical activity.”
    • Also stated in: § Physical activity · plain
      “The CGM-Fit group maintained their physical activity levels between baseline and six months. In contrast, those in the CGM group showed a reduction in their physical activity (−540 MET minutes/week, p < 0.01).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    There were no changes to time spent in hypoglycemia or time spent below range.

    “with no changes to time spent in hypoglycemia or time spent below range.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    Regarding medication, 23.4% of participants experienced an increase, 35.0% a decrease, and 41.6% maintained their medication dose.

    “Regarding medication, 23.4% of participants experienced an increase, 35.0% a decrease, and 41.6% who maintained their medication dose.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    HbA1c reduced significantly between baseline and 3 months by 1.5% in both groups, independent of weight changes.

    “HbA1c reduced significantly (p < 0.0001) between baseline and 3 months by 1.5% in both groups, independent of weight changes.”
    • Also stated in: § HbA1c · plain
      “HbA1c significantly decreased absolutely by 1.5% from baseline at the third month of follow-up but rebounded between the third and sixth months of follow-up.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    There were no statistical differences between medication changes prior to CGM enrollment and at the first routine Doctor visit (Study visit 5), and between groups.

    “There were no statistical differences between medication changes prior to CGM enrollment and at the first routine Doctor visit (Study visit 5), and between groups.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    At 6 months, 73% of participants experienced a decreased HbA1c from baseline, less than 1% remained unchanged, and 26.4% experienced an increase.

    “At the end of the study (6 months follow-up), 73% of participants experienced a decreased HbA1c from baseline, less than 1% remained unchanged, and 26.4% experienced an increase.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    Both groups demonstrated sufficient CGM data capture at each two weeks (89.8%, 90.8%, 92%), with an average wear time of 14 days and 6-7 scans per day.

    “Both groups demonstrated sufficient CGM data capture at each two weeks (89.8%, 90.8%, 92%), with an average wear time of 14 days and 6–7 scans per day.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    The study participants had a median BMI of 28.2 kg/m2 (IQR 25.1-31.6).

    “The median HbA1c was 9.7% (8.8, 10.4), and BMI 28.2 kg/m2 (25.1, 31.6).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    The study population was predominantly male (55%) and Chinese (43%).

    “There were predominantly males (55%) and Chinese ethnicity (43%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    The study participants had a median HbA1c of 9.7% (IQR 8.8-10.4).

    “The median HbA1c was 9.7% (8.8, 10.4), and BMI 28.2 kg/m2 (25.1, 31.6).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    These changes were independent of body weight, which remained stable over the study duration.

    “These changes were independent of body weight, which remained stable over the study duration.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    There was a rebound in HbA1c levels six months after the final CGM, but the improvement in HbA1c remained significant, with a mean decrease of 0.8%.

    “There was a rebound in HbA1c levels six months after the final CGM, but the improvement in HbA1c remained significant, with a mean decrease of 0.8%.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    There were 69.6% participants on insulin therapy.

    “There were 69.6% participants on insulin therapy.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationown data

    This study found that sequential CGM significantly improved glycemic control, comparable to available glucose-lowering agents.

    “This study found that sequential CGM significantly improved glycemic control, comparable to available glucose-lowering agents.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationown data

    Using an exercise tracker may help sustain physical activity and glycemic control.

    “Using an exercise tracker may help sustain physical activity and glycemic control.”
    • Also stated in: § Discussion · plain
      “The concurrent use of an exercise tracker helps maintain physical activity and sustain glycemic improvement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    The three interactions between patients and DNEs were crucial in enhancing self-efficacy.

    “The three interactions between patients and DNEs were crucial in enhancing self-efficacy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may state two separate claims as one.

    Premisecitation

    Chronic hyperglycemia increases the risk of serious comorbidities, and even 1% reductions in glycated hemoglobin can significantly lower the risk of morbidity and mortality.

    “Chronic hyperglycemia increases the risk of serious comorbidities, however, even 1% reductions in glycated hemoglobin can significantly lower the risk of morbidity and mortality [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Leslie RD. United Kingdom prospective diabetes study (UKPDS): what now or so what? Diabetes Metab Res Rev. 1999;15(1):65–71. source

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    These trackers help to highlight patients' cognitive dissonance between entrenched health beliefs or perceptions and objective information from the wearables.

    “However, these trackers help to highlight patients’ cognitive dissonance, between entrenched health beliefs or perceptions and objective information from the wearables.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    A total of 122 participants completed two dietitian counselling sessions, and nine completed one.

    “A total of 122 participants completed two dietitian counselling sessions, and nine participants completed one dietitian counselling session.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Optimizing lifestyle interventions, including diet and exercise, are essential for managing T2D due to their cost-effectiveness and health benefits.

    “Optimizing lifestyle interventions, including diet and exercise, are essential for managing T2D due to their cost-effectiveness and health benefits [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Franz MJ, MacLeod J, Evert A, et al. Academy of Nutrition and Dietetics Nutrition Practice Guideline for Type 1 and Type 2 Diabetes in Adults: systematic review of evidence for medical nutrition therapy effectiveness and recommendations for integration into the nutrition care process. J Acad Nutr Diet. 2017;117(10):1659–79. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    Of 165 patients recruited, 138 completed the study, with 73 in the CGM group and 65 in the CGM-Fit group.

    “Of 165 patients recruited, 138 completed the study. Seven patients withdrew before CGM initiation and 20 withdrew during the study period, resulting in 73 participants in the CGM group and 65 in CGM-Fit group who completed the study (Fig. 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The study did not have a control group that monitored capillary blood glucose (SMBG), periodic CGM or a single ad hoc CGM.

    “We did not have a control group that monitored capillary blood glucose (SMBG), periodic CGM or a single ad hoc CGM.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Randomization was done using a coin toss method before patient recruitment.

    “Randomization was done using a coin toss method before patient recruitment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Interpretationnone given

    The study was a single-center study conducted in Singapore, which may affect generalizability.

    “There are some limitations, notably, this was a single-center study conducted in Singapore.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    The potential of CGM lies in its ability to provide real-time feedback and facilitate a deeper understanding of the interplay between lifestyle choices and treatment effects.

    “The potential of CGM lies in its ability to provide real-time feedback and facilitate a deeper understanding of the interplay between lifestyle choices and treatment effects.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductown data

    The research received ethical approval and participants provided informed consent.

    “The research received ethical approval from the Institutional Review Board of the National Health Group in Singapore, and participants provided informed consent before the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Interpretationreasoning

    The cultural and infrastructural facets of local healthcare may affect the generalizability of these results.

    “Although our population was ethnically diverse, the cultural and infrastructural facets of local healthcare may affect the generalizability of these results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductown data

    The study did not test a group without diabetes education or dietary advice.

    “We also did not test a group without diabetes education or dietary advice.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductown data

    Participants underwent stratified randomization by trial administrator based on sex and age into two groups.

    “For this purpose, participants underwent stratified randomization by the trial administrator based on sex and age into two groups: sequential CGM alone (CGM) or sequential CGM with a Fitbit (FITBIT INSPIRE HR), a wearable exercise tracker (CGM-Fit).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductcitation

    Exercise levels were quantified using the World Health Organization Global Physical Activity Questionnaire.

    “Exercise levels were quantified at each visit using the World Health Organization Global Physical Activity Questionnaire [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] World Health Organization. (2021) Global physical activity questionnaire (GPAQ). In: www.who.int. https://www.who.int/publications/m/item/global-physical-activity-questionnaire

  • It may state two separate claims as one.

    Premisecitation

    Peng et al. synthesized 25 studies examining the use of fitness trackers in managing patients with T2D, but these studies focused on achieving weight loss, which led to consequent improvement of HbA1c.

    “Peng et al. [13] synthesized 25 studies examining the use of fitness trackers in managing patients with T2D. However, these studies focused on achieving weight loss, which led to consequent improvement of HbA1c.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Peng P, Zhang N, Huang J, Jiao X, Shen Y. (2023) Effectiveness of wearable activity monitors on metabolic outcomes in patients with type 2 diabetes: a systematic review and meta-analysis. Endocr Pract. 2023;29(5):368–378. source

  • It may state two separate claims as one.

    Interpretationreasoning

    The study design used three consecutive CGM: the first demonstrated how lifestyle habits can influence blood glucose levels (self-awareness); the second engaged patients in changing their lifestyle (assisted adjustment); and the third consolidated these efforts (self-adjustment).

    “We used three consecutive CGM: the first demonstrated how lifestyle habits can influence blood glucose levels (self-awareness); the second engaged patients in changing their lifestyle (assisted adjustment); and the third consolidated these efforts (self-adjustment).”
    Quote in the paperSubstantial claim
38 of 38

  • The paper relies on this without support.

    This is the first study combining sequential CGM and wearable fitness trackers with the primary aim of reducing HbA1c in patients with T2D.

    “To our knowledge, this is the first study combining sequential CGM and wearable fitness trackers with the primary aim of reducing HbA1c in patients with T2D.”

  • The paper relies on this without support.

    There is a notable gap in understanding the long-term benefits of CGM beyond controlled experimental settings.

    “However, while many studies indicate positive short-term outcomes with CGM usage, there remains a notable gap in understanding the long-term benefits of these technologies beyond controlled experimental settings.”

  • The paper relies on this without support.

    Participants in the CGM-Fit group wore the Fitbit throughout the day and synced data regularly as advised.

    “In the CGM-Fit group, the participants wore the exercise tracker for the full six-month study period. Advice regarding the Fitbit was limited to wearing the monitor throughout the day and syncing the data regularly.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • A baseline count exceeds the stated final-analysis cohort

    Major

    Table 1 is labeled as describing 138 participants in the final analysis, yet reports 149 participants with hyperlipidemia.

  • Figure 3 describes 12 months of data in a six-month study

    Minor

    The caption calls the HbA1c trend a 12-month trend, while the study is described as lasting six months and its stated follow-ups end at month six.

2 of 2

Citations

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Metadata

Authors
Lahiri, A., Lim, S. T., Kyu, H., Dan, Y. Y., & Khoo, C. M.
Affiliations
  • University of Birmingham (GB)
  • National University Hospital (SG)
  • National University of Singapore (SG)
Corresponding author
Khoo, Chin Meng
ORCID
Venue
Diabetology & Metabolic Syndrome
Publisher
Springer Science and Business Media LLC
Published
2025-11-22
Volume
18
Issue
1
Pages
1-1
ISSN
1758-5996 (ISSN-L)
DOI
10.1186/s13098-025-02035-6
PMC
PMC12764008
OpenAlex
W4416558332
Semantic Scholar
ebd1054fbe845a5d4f418ac94712a5567fde2a45
Cited by
1
References
17
Citations by year
2026: 1
FWCI
0.55
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetology & Metabolic Syndrome (publishedVersion, cc-by-nc-nd)
  • Research Square (submittedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National University Health System AHS Mission Fund
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
type 2 diabetes, glycemic control, Fitbit, HbA1c, time in range, physical activity, diabetes education, nutrition counseling, middle-aged adults

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-09, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-09 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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