Continuous glucose monitoring as a tool for psychological support - exploring metabolic control and psychological well-being after initial cgm implementation in adults with type 1 diabetes (Preprint)

Abstract

BACKGROUND January 2023 marked a significant breakthrough for type 1 diabetes treatment in Poland, as the reimbursement of intermittently scanned CGM (isCGM)/continuous glucose monitoring (CGM) was initiated for individuals aged 26 and older. OBJECTIVE Assessment of changes in quality of life, metabolic control, fear of hypoglycemia and selected psychological parameters after implementation of the isCGM/CGM in people with type 1 diabetes (PwT1D) aged 26 and above. METHODS The study involved 57 PwT1D from five Polish diabetology centers. To be included in the study, each participant had to be at least 26 years old, have a minimum of two years of diabetes history, and be treated with multiple daily injections or a personal insulin pump. The exclusion criterion from the study was the use of isCGM/CGM for more than two weeks prior to the study. Participants completed a set of validated questionnaires: Hypoglycemia Fear Survey-II (FSH-II); Diabetes Distress Scale (DDS); Perceived Stress Scale (PSS10); Diabetes Treatment Satisfaction Questionnaire status version (DTSQs); World Health Organization Well-Being Index (WHO-5); Problem Areas in Diabetes (PAID); Diabetes Burnout Questionnaire (DBQ), and sociodemographic survey, downloaded 14-day pump/glucometer data, and underwent HbA1c measurement during visits. After 3 months of CGM use, participants repeated assessments, isCGM/CGM reports were also re-evaluated. RESULTS Slightly more than half of the participants were male (n=29, 50.9%). The median age of the group was 37.5 years (IQR 29.5-46.0 years), while the median duration of diabetes was 16 years (IQR 29.5-46.0 years). After 3 months of using CGM, individuals reported higher treatment satisfaction measured by DTSQs (median 27.0 vs 30.0, p=0.01) and less frequently experienced unacceptably high glycemia (median 4.0 vs 3.0, p<0.001). Well-being assessment according to WHO-5 was also higher (mean 13.1 vs 14.3, p=0.04), and the level of diabetes burnout measured by DBQ (median 3.0 vs 1.0, p<0.001), fear of hypoglycemia assessed by HFS-II (median 41.0 vs 30.5, p=0.03) significantly decreased. Diabetic distress measured by means of total score of DDS lowered from 2.7 to 2.0 (p=0.001), with decreased scores in emotional burden, regimen distress and interpersonal distress subscales. Participants scored also lower on PAID upon follow up (median 36.8 vs 21.3, p=0.001). However, the average stress level measured by PSS-10 did not change (p=0.94). Regarding glycemic control, the percentage of HbA1c after three months of using the system was significantly lower (7.3 vs 7.1%, p=0.01). CONCLUSIONS The use of isCGM/CGM, even during relatively short observation, leads to improved quality of life, reduced fear of hypoglycemia and diabetes burnout, and lower HbA1c levels in PwT1D over the age of 26 who were naïve to this technology. These psychological and metabolic benefits support expanding isCGM and CGM use to a broader range of patients. CLINICALTRIAL NA