Initial experiences of adolescents and young adults with type 1 diabetes and high-risk glycemic control after starting flash glucose monitoring - a qualitative study

Boucher, Sara E; Blackwell, Miranda; Galland, Barbara; Bock, Martin de; Crocket, Hamish; Wiltshire, Esko; Tomlinson, Paul; Rayns, Jenny; Wheeler, Benjamin J

doi:10.1007/s40200-019-00472-5

Cited by 13 publications

(14 citation statements)

References 42 publications

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“…In pediatric patients isCGM reduced psychological distress for all the domains analyzed during a 12-weeks prospective study in children/adolescents [( 44 ), Moderate] and in a 4-weeks qualitative study in adolescents/young adults [( 45 ), Low]. This effect was reported also in parents of children and adolescents in a qualitative study [( 46 ), Low].…”

Section: Distress/diabetes Burdenmentioning

confidence: 77%

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Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients

Franceschi

Micheli

Mozzillo³

et al. 2021

Front. Pediatr.

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Aim: To explore the impact of real-time continuous glucose monitoring (rtCGMs) or intermittently scanned/viewed CGM (isCGM) on psychological outcomes in children and caregivers, and to grade the level of evidence.Method: Systematic review of the literature from PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Nursing reference center, Up to date, Google Scholar, and PsycINFO databases. The studies selected used validated questionnaires for investigating the psychological outcomes. We applied GRADE (Grading of Recommendations Assessment, Development and Evaluation) to rank the quality of a body of evidence.Results: A total of 192 studies were identified in the initial search and after the process of evaluation 25 studies were selected as appropriate to be included in this systematic review. We found in moderate quality studies that isCGM in adolescents can improve diabetes related distress, family conflicts, fear of hypoglycemia, and quality of life, while depression, anxiety, and quality of sleep have not yet been evaluated by validated questionnaires. In moderate—high quality studies, rtCGM technology does not impact on diabetes burden, diabetes specific family conflict, and depressive symptoms. The effect on fear of hypoglycemia, sleep quality, and anxiety is still debated and RCT studies powered to find significant results in psychological outcomes are lacking. RtCGM increases satisfaction and quality of life in parents and patients wearing rtCGM.Conclusion: these data present an interesting point to consider when families are deciding whether or not to start CGM use, choosing between rtCGM to reach a tighter metabolic control, or isCGM which allows greater benefits on psychological outcomes.

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Section: Distress/diabetes Burdenmentioning

confidence: 77%

“…IsCGM use was associated with a reduction in diabetes specific parent-child conflict and parental conflict in patients aged 13–20 years in 2 qualitative studies [( 45 , 46 ), Low].…”

Section: Family Conflict In the Management Of Diabetesmentioning

confidence: 99%

Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients

Franceschi

Micheli

Mozzillo³

et al. 2021

Front. Pediatr.

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“…diabetes-and nondiabetes-related burden, including diabetes distress (30), stigma (31), depression (32), and family conflict (33). Clearly, despite improved glucose-checking frequency and diabetes satisfaction and overwhelmingly positive participant and family experiences with isCGM in this trial (34,35), gains in traditionally measured psychosocial outcomes such as quality of life were not seen at 6 months. For the majority of these individuals, improving psychosocial outcomes may require more intensive input, beyond just reducing invasive glucose monitoring and access to more glucose data.…”

Section: Discussionmentioning

confidence: 87%

Effect of 6 Months of Flash Glucose Monitoring in Youth With Type 1 Diabetes and High-Risk Glycemic Control: A Randomized Controlled Trial

et al. 2020

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To investigate whether intermittently scanned continuous glucose monitoring (isCGM) significantly improves glycemic control compared with capillary selfmonitored blood glucose (SMBG) in youth with type 1 diabetes and high-risk glycemic control. RESEARCH DESIGN AND METHODSThis multicenter 6-month randomized, controlled, parallel-arm trial included 64 participants aged 13-20 years with established type 1 diabetes and glycated hemoglobin (HbA 1c ) ‡9% ( ‡75 mmol/mol). Participants were allocated to 6-month intervention (isCGM; FreeStyle Libre; Abbott Diabetes Care, Witney, U.K.) (n 5 33) or control (SMBG; n 5 31) using minimization. The primary outcome was the difference in change in HbA 1c from baseline to 6 months. RESULTSThere was no evidence of a difference between groups for changes in HbA 1c at 6 months (adjusted mean 0.2% greater improvement for isCGM [95% CI 20.9 to 0.5] [22.1 mmol/mol (95% CI 29.6 to 5.4)]; P 5 0.576). However, glucose-monitoring frequency was 2.83 (95% CI 1.72-4.65; P < 0.001) times higher in the isCGM group compared with that in the SMBG group at 6 months. The change in the Diabetes Treatment Satisfaction Questionnaire mean item score also favored isCGM at 6 months (P 5 0.048), with no significant differences between groups for fear of hypoglycemia and quality of life (both general and diabetes specific) (all P > 0.1). CONCLUSIONSFor youth with high-risk glycemic control, isCGM led to improvements in glucose testing frequency and diabetes treatment satisfaction. However, these did not translate to greater improvement in glycemic control over usual care with SMBG at 6 months.Glucose monitoring is a fundamental component of type 1 diabetes care (1). Frequency of self-monitoring of blood glucose (SMBG) via intermittent finger-prick capillary glucose measurements is related to glycemic control, with improvements in glycated hemoglobin (HbA 1c ) of up to 0.5% (5 mmol/mol) for each additional glucose check, up to five per day (2). However, this degree of monitoring represents a considerable management burden and can lead to reduced adherence (3).

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“…isCGM, intermittently scanned continuous glucose monitoring; SMBG, self monitoring blood glucose people who are struggling to achieve the recommended glycaemic targets. 20 Although adolescents and young adults with high-risk T1D find isCGM an acceptable tool to increase glucose test frequency, 21 this age group continue to struggle with adherence to technology 19 and nontechnology interventions, 22 limiting our ability to make lasting differences to their glycaemic outcomes and highlighting the complexity of input required to manage diabetes in this population. It is acknowledged that ethnicity and social deprivation are also contributing factors, 23 with Māori and Pacific Peoples making up 41% of participants in this study.…”

Section: Discussionmentioning

confidence: 99%

Use of intermittently scanned continuous glucose monitoring in young people with high‐risk type 1 diabetes—Extension phase outcomes following a 6‐month randomized control trial

et al. 2021

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Aims: To describe the impact of a 12-month intervention using intermittently scanned continuous glucose monitoring (isCGM) on glycaemic control and glucose test frequency in adolescents and young adults with type 1 diabetes (T1D) and high-risk glycaemic control (HbA 1c ≥75 mmol/mol [≥9.0%]). Methods:In total, 64 young people (aged 13-20 years, 16.6 ± 2.1 years; 48% female; 41% Māori or Pacific ethnicity; mean diabetes duration 7.5 ± 3.8 years) with T1D were enrolled in a 6-month, randomized, parallel-group study comparing glycaemic outcomes from the isCGM intervention (n = 33) to self monitoring blood glucose (SMBG) controls (n = 31). In this 6-month extension phase, both groups received isCGM; HbA 1c , glucose time-in-range (TIR), and combined glucose test frequency were assessed at 9 and 12 months.

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Initial experiences of adolescents and young adults with type 1 diabetes and high-risk glycemic control after starting flash glucose monitoring - a qualitative study

Cited by 13 publications

References 42 publications

Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients

Intermittently Scanned and Continuous Glucose Monitor Systems: A Systematic Review on Psychological Outcomes in Pediatric Patients

Effect of 6 Months of Flash Glucose Monitoring in Youth With Type 1 Diabetes and High-Risk Glycemic Control: A Randomized Controlled Trial

Use of intermittently scanned continuous glucose monitoring in young people with high‐risk type 1 diabetes—Extension phase outcomes following a 6‐month randomized control trial

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