- βHybrid closed-loop insulin systems produced the greatest blood sugar improvementsβespecially in children under 18βbut most patients still weren't using CGM even after it became covered.
| Journal | Annals of pediatric endocrinology & metabolism |
| Year | 2026 |
| Authors | Yordsudueam, Numsriskulrat, Lerdrassameethad |
| PMID | 41354744 |
| DOI | 10.6065/apem.2550096.048 |
What This Study Found
In mid-2023, Thailand added continuous glucose monitoring (CGM) to its national health coverage program for people with type 1 diabetes. Researchers at one major hospital tracked 142 patients over 12 months to see what changed. The biggest blood sugar improvements happened in patients using a hybrid closed-loop (HCL) system β a device that combines a CGM with an insulin pump that automatically adjusts doses.
Why This Matters for People With Type 1 Diabetes
This study is a real-world look at what happens when CGM becomes more affordable β and what still gets in the way. Even after coverage kicked in, only 12% of eligible patients at this center started using CGM. That's a surprisingly small number, and it points to something important: cost is only one barrier. Education, awareness, and hands-on support matter just as much.
Breaking Down the Results
The study compared four groups of patients:
- Self-monitoring (finger sticks only)
- CGM alone
- Open-loop insulin pump (pump without automatic adjustments)
- Hybrid closed-loop (HCL) β pump plus CGM that works together automatically
Here's what the numbers showed after 12 months:
- The HCL group had the largest A1C drop: -0.99% on average
- In patients under age 18 using HCL, the drop was even bigger: -1.21%
- CGM-only users saw a modest A1C improvement of -0.29%, and more of them reached the target of 70% time in range β though this difference wasn't statistically significant
- The HCL group spent more time in the healthy blood sugar range and wore their sensors more consistently
What Is Time in Range?
Time in range (TIR) measures how many hours per day your blood sugar stays in a healthy zone β usually between 70 and 180 mg/dL. Most diabetes guidelines aim for at least 70% TIR. In this study, more CGM users hit that goal after 12 months (69.2%) compared to before (47.1%), though the difference was not statistically significant β meaning it could partly be due to chance in this small group.
The Bigger Picture
This study was done at just one hospital in Thailand, and the number of patients in some groups was small. That means we can't draw firm conclusions for everyone. But the pattern is consistent with research from other countries: automated insulin delivery systems that combine a pump and CGM tend to outperform finger sticks or CGM alone β especially for younger patients.
The low adoption rate (12%) is a wake-up call. Making CGM affordable is a first step, but patients also need support figuring out how to use it and stick with it long-term.
What You Can Do
If you or your child has type 1 diabetes and you're not yet using a CGM, it's worth asking your care team whether it's right for you. CGM gives you real-time data that finger sticks simply can't provide β and when paired with the right insulin delivery system, the results can be meaningful.
At mdsdiabetes.com, you can explore CGM supplies, sensors, and diabetes management tools that support better day-to-day control. Our team is here to help you understand your options.
β Key Takeaway
Hybrid closed-loop systems β which combine CGM with an automatic insulin pump β produced the strongest blood sugar improvements in this study, particularly in children and teens with type 1 diabetes. But even when CGM became covered by insurance, most patients didn't start using it, showing that access alone isn't enough.
Citation: Yordsudueam, Numsriskulrat, Lerdrassameethad (2026). Preliminary clinical outcomes and adoption of continuous glucose monitoring following reimbursement implementation in patients with type 1 diabetes in Thailand. Annals of Pediatric Endocrinology & Metabolism. PMID: 41354744. DOI: 10.6065/apem.2550096.048