Aims To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes.Methods Twenty adult patients (aged 45 AE 15 years, diabetes duration 25 AE 19 years, 50% female) followed at our site in the multi-centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into three groups: Glycated haemoglobin (HbA 1c ) Responders who demonstrated an improvement in glycaemic control with continuous glucose monitoring (baseline HbA 1c ‡ 7.0%, HbA 1c reduction greater than or equal to 0.5%), Hypoglycaemia Responders (baseline HbA 1c < 7.0%) who demonstrated decreased time < 3.9 mmol ⁄ l while remaining within target HbA 1c , and HbA 1c NonResponders (baseline HbA 1c ‡ 7.0%, HbA 1c reduction less than 0.5%). Subjects participated in semi-structured interviews focusing on their psychosocial experiences with continuous glucose monitoring.Results Three major themes were identified that differentiated Responders (including both the HbA 1c and Hypoglycaemia groups) from Non-Responders: (i) coping with frustrations-Responders used self-controlled rather than emotions-based coping when faced with continuous glucose monitoring frustrations; (ii) use of information-Responders used retrospective pattern analysis, not just minute-by-minute data analysis, in glycaemic management; (iii) 'significant other' ⁄ spousal involvement-Responders endorsed interest, encouragement and participation by their loved ones. Both Responders and Non-Responders expressed body image concerns when wearing continuous glucose monitoring devices.Conclusions This qualitative study points to the importance of coping skills, retrospective review of data, and 'significant other' involvement in the effective use of continuous glucose monitoring. These findings will inform clinical initiatives to improve patient selection and training in the use of this new technology and have served as the basis for development of quantitative surveys to be used in clinical practice.

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In terms of population trends, the association between depression and cigarette smoking became prominent as the use of tobacco declined because of awareness of the risks involved. The findings about individuals followed over time suggest that those who became depressed were more involved with nicotine than those who never had a depression. The authors discuss hypotheses involving "self-medication," risk-taking, and changes in the social climate but conclude that the relationships between smoking and depression are probably multiple and complex.

The relationships between anxiety and depression remained similar over time with the exception that depression came to resemble anxiety as a disorder to which women were significantly more vulnerable than men. Social and historical factors should be investigated to assess their relevance to this change.