A Standardized Outpatient Workflow for Continuous Glucose Monitoring and Thyroid Function Profiling in Adults with Type 2 Diabetes and Metabolic Risk

Continuous glucose monitoring (CGM) and thyroid function screening are often applied in isolation during routine outpatient care for type 2 diabetes mellitus, leaving detected abnormalities inconsistently translated into clinical action. This trial evaluated a standardized, low-training-threshold outpatient workflow integrating CGM-based glycemic management with systematic thyroid screening. In this prospective, randomized, parallel-group controlled trial, 180 adults with type 2 diabetes and metabolic risk were assigned 1 to 1 to a standardized workflow, including a dedicated care-coordinator nurse, uniform CGM protocol, structured thyroid assessment, and threshold-triggered decision support, or to conventional outpatient management. The primary outcome was 12-week change in CGM-derived time in range (TIR). Among 146 participants in the final analysis (73 per group), the intervention produced a significantly greater improvement in TIR, with an adjusted between-group difference of 6.9 percentage points (95% CI, 4.3 to 9.5; P<0.001), alongside greater HbA1c reduction and higher patient satisfaction. Among patients with abnormal thyroid findings, standardized management or referral was achieved in 94.1% of the intervention group versus 53.8% of controls (P=0.008), with no increase in hypoglycemic events. This standardized workflow improved glycemic control and thyroid-related care completion without compromising safety, offering a scalable model for integrated outpatient diabetes management.