Continuous Glucose Monitoring to support behaviour change in adults with new-onset prediabetes

This is a single-centre, non-blinded, single-arm, prospective, interventional pilot study conducted at Royal Prince Alfred HealthOne Green Square. At Visit 1, all participants (n=24) will undergo physical examination (height, weight, waist circumference, blood pressure) and have routine pathology performed at our onsite pathology collection service (NSW Health Pathology). They will complete questionnaires about their demographics, medical history, food habits, physical activity habits and quality of life. Participants will formally record their dietary and physical activity habits and quality of life at baseline and end-of-study using validated questionnaires ("Starting the Conversation Diet", "International Physical Activity Questionnaire short", and Medical Outcomes Study SF-20 Questionnaire", respectively). They will be provided with National Diabetes Services Scheme fact sheets on “Understanding Prediabetes”, “Healthy Food Choices”, “The Glycaemic Index”, and “Physical Activity” to help them understand their prediabetes and how to manage it. Healthy lifestyle goals will be discussed, agreed upon, and documented for the participant. A Freestyle Libre 2 Continuous Glucose Monitoring (CGM) sensor (the intervention) will be applied to the back of the arm of each participant by an experienced clinic doctor or nurse. Participants will be provided verbal and written ("Your Complete Guide to Freestyle Libre 2") information on how to scan the sensor with their own compatible smartphone and how to interpret their glucose data on the LibreLink App. They will also be shown how to notate activities/events (e.g. went for a hike, birthday party, stressful day at work, etc) on the LibreLink App. Participants will be encouraged to engage in real time with their glucose data, and recognise how different factors (e.g. food, activity, sleep, stress, medicines) affect blood glucose levels. This forms the basis for biofeedback from CGM to promote behaviour change. After the sensor has expired (two weeks) participants can remove the sensor (peeled off the skin), and they will be followed up by phone call (Visit 2). Libre 2 CGM data will be downloaded via the LibreView Dashboard, reviewed and discussed with the participant. Participants will answer a “CGM Experience Survey” describing their experience using the Libre 2 sensor. Between Visit 2 and Visit 3, participants will be given the option to undertake “Achievement Check-ins”, where each fortnight, they can email their self-reported bodyweight and progress with behaviour change. A generic feedback email will be sent in reply. The process of Visit 1 and Visit 2 will then be repeated three months later, as Visit 3 and Visit 4. The second Libre 2 sensor will be applied during Visit 3 for the purpose of capturing detailed glucose metrics (unlike during Visit 1, where the sensor was used as the study intervention) and the “CGM Experience Survey” will be repeated. Participants will also be asked to complete an “End of Study Survey”. Visit 1 and 3 will be face-to-face in the outpatient clinic and will take ~1 hour each. Visit 2 and 4 will be offered via telehealth and will take 15-30 minutes each. We will use a session attendance checklist to monitor adherence to the intervention and the study protocol.