RT-CGM in adults with type 1 diabetes improves both glycaemic and patient-reported outcomes, but independent of each other. (December 2019)

• Record Type: Journal Article
• Authors: Nefs, Giesje; Bazelmans, Ellen; Marsman, Diane; Snellen, Niels; Tack, Cees J.; de Galan, Bastiaan E.
• Is Part Of: Diabetes research and clinical practice. Volume 158(2019)
• Publication Date: 2019-12
• Subjects: Continuous glucose monitoring -- Regular care -- Glycaemic outcomes -- Patient-reported outcomes -- Distress -- Coping; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2019.107910
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: In type 1 diabetes, RT-CGM improved HbA1c, diabetes worries and self-efficacy. Persons with more suboptimal HbA1c and PRO values benefit most from RT-CGM. Glycaemic and PRO improvements were not interrelated. Lower conscientiousness and higher hypo worries did predict reduction in HbA1c . Both medical outcomes and PROs should be included in individual RT-CGM evaluation. Abstract: Aims: To examine in adults with type 1 diabetes (a) the effect of initiation of real-time continuous glucose monitoring (RT-CGM) on glycaemic and patient-reported outcomes (PROs), and (b) factors related to clinically relevant improvements and sustained device use. Methods: 60 persons initiating RT-CGM completed questionnaires at device start and six months later. Demographics and clinical characteristics including (dis)continuation up until July 31st 2018 were obtained from medical records. Results: After six months, 54 adults were still using RT-CGM. Short-term discontinuation (10%) was mainly related to end of pregnancy (wish). Longer-term discontinuation in those with an initial non-pregnancy indication was related to changes in the medical condition and behavioural/psychological reasons. After six months, HbA1c, diabetes-specific worries and self-efficacy improved (range d = |0.4|–|0.8|), while hypoglycaemia rate or awareness and more general distress did not change. More suboptimal scores at baseline were related to meaningful improvements in HbA1c (≥10 mmol/mol; 0.9%) and PROs (≥0.5 SD). Changes in glycaemic variables and PROs were not related. Conclusions: People with more suboptimal HbA1c and PRO values appear to benefit most from RT-CGM. Given the lack of association between improvements in medical outcomes and PROs, both should be included in evaluations of RT-CGM therapy on an individual level.