Observational study of the relationship between the use of real-time continuous glucose monitoring and glycemic control in patients with diabetes in Japan: the REALJ study
Abstract
Although randomized controlled trials have demonstrated the efficacy of real-time continuous glucose monitoring (rtCGM), evidence from routine clinical practice remains limited, particularly in Asian populations. This study aimed to evaluate the effectiveness and safety of rtCGM initiation in individuals with diabetes. This multicenter, single-arm, retrospective, observational study was conducted at 34 sites across Japan (Clinical trial registration: UMIN000054275). Adults ≥18 years of age with diabetes who began using the Dexcom G6 rtCGM system, had a baseline glycated hemoglobin (HbA1c) level ≥7.5%, and continued rtCGM for at least 26 weeks were included. Factors associated with changes in HbA1c levels were examined using multivariate linear regression models. Among 192 participants, the mean HbA1c levels at 26 weeks were significantly lower (8.62 ± 1.14% vs. 7.88 ± 1.16%, p < 0.001) than those at baseline, with a difference of -0.73 ± 1.03%. In the multivariate analysis, greater HbA1c reduction was independently associated with higher baseline HbA1c (β = -0.40; p < 0.001), longer CGM active time (β = -0.008; p = 0.043), and older age (β = -0.010; p = 0.012), whereas prior isCGM use was associated with smaller reductions (β = +0.28; p = 0.045). Sex was also independently associated with changes in HbA1c levels (p = 0.028). During the 26-week follow-up period, one patient (0.5%) experienced diabetic ketoacidosis and four individuals (2.1%) experienced severe hypoglycemia. rtCGM initiation was associated with significantly lower HbA1c levels after 26 weeks of rtCGM use. These findings support the efficacy and safety of the Dexcom G6 in routine clinical practice.
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BibTeX
@article{toyoda2026observational,
title = {{Observational study of the relationship between the use of real-time continuous glucose monitoring and glycemic control in patients with diabetes in Japan: the REALJ study}},
author = {Masao Toyoda and Naoki Sakane and Akiko Suganuma and Masahito Ogura and Junnosuke Miura and Daisuke Tsuriya and Akinori Hayashi and Hideaki Sawaki and Shota Suzuki and Tatsuhiko Urakami and Yushi Hirota and Arata Itoh and Shu Meguro and Kenji Kamiuchi and Tomokazu Matsuda and Hitomi Nakayama and Yoshihiko Yuyama and Tomoyuki Kawamura and Atsuhito Tone and Ken Kato and Akira Kuroe and Akio Kuroda and Munehide Matsuhisa and Akira Shimada and Takashi Murata and The REALJ Study Group},
journal = {Endocrine Journal},
year = {2026},
month = aug,
doi = {10.1507/endocrj.ej26-0183},
url = {https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ26-0183/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Observational study of the relationship between the use of real-time continuous glucose monitoring and glycemic control in patients with diabetes in Japan: the REALJ study
AU - Masao Toyoda
AU - Naoki Sakane
AU - Akiko Suganuma
AU - Masahito Ogura
AU - Junnosuke Miura
AU - Daisuke Tsuriya
AU - Akinori Hayashi
AU - Hideaki Sawaki
AU - Shota Suzuki
AU - Tatsuhiko Urakami
AU - Yushi Hirota
AU - Arata Itoh
AU - Shu Meguro
AU - Kenji Kamiuchi
AU - Tomokazu Matsuda
AU - Hitomi Nakayama
AU - Yoshihiko Yuyama
AU - Tomoyuki Kawamura
AU - Atsuhito Tone
AU - Ken Kato
AU - Akira Kuroe
AU - Akio Kuroda
AU - Munehide Matsuhisa
AU - Akira Shimada
AU - Takashi Murata
AU - The REALJ Study Group
PY - 2026
DA - 2026/08/18
JO - Endocrine Journal
DO - 10.1507/endocrj.ej26-0183
UR - https://www.jstage.jst.go.jp/article/endocrj/advpub/0/advpub_EJ26-0183/_article
AB - Although randomized controlled trials have demonstrated the efficacy of real-time continuous glucose monitoring (rtCGM), evidence from routine clinical practice remains limited, particularly in Asian populations. This study aimed to evaluate the effectiveness and safety of rtCGM initiation in individuals with diabetes. This multicenter, single-arm, retrospective, observational study was conducted at 34 sites across Japan (Clinical trial registration: UMIN000054275). Adults ≥18 years of age with diabetes who began using the Dexcom G6 rtCGM system, had a baseline glycated hemoglobin (HbA1c) level ≥7.5%, and continued rtCGM for at least 26 weeks were included. Factors associated with changes in HbA1c levels were examined using multivariate linear regression models. Among 192 participants, the mean HbA1c levels at 26 weeks were significantly lower (8.62 ± 1.14% vs. 7.88 ± 1.16%, p < 0.001) than those at baseline, with a difference of -0.73 ± 1.03%. In the multivariate analysis, greater HbA1c reduction was independently associated with higher baseline HbA1c (β = -0.40; p < 0.001), longer CGM active time (β = -0.008; p = 0.043), and older age (β = -0.010; p = 0.012), whereas prior isCGM use was associated with smaller reductions (β = +0.28; p = 0.045). Sex was also independently associated with changes in HbA1c levels (p = 0.028). During the 26-week follow-up period, one patient (0.5%) experienced diabetic ketoacidosis and four individuals (2.1%) experienced severe hypoglycemia. rtCGM initiation was associated with significantly lower HbA1c levels after 26 weeks of rtCGM use. These findings support the efficacy and safety of the Dexcom G6 in routine clinical practice.
SN - 1348-4540
SN - 0918-8959
ER -