Perceived Burdens and Benefits Associated With Continuous Glucose Monitor Use in Type 1 Diabetes Across the Lifespan

Abstract

Background: Continuous glucose monitors (CGMs) help people with type 1 diabetes (T1D) improve their glycemic profiles but are underutilized. To better understand why, perceived CGM burdens and benefits in nonusers versus users with type 1 diabetes across the lifespan were assessed. Methods: Burdens (BurCGM) and benefits of CGM (BenCGM) questionnaires were completed during T1D outpatient visits ( n = 1334) from February 2019 to February 2020. Mean scores were calculated (scale one to five; higher scores reflect greater perceived burdens/benefits). Data were collected from medical records including glycated hemoglobin (HbA1c) within 3 months of the visit. Results: Individuals of all ages using CGM described more benefits and less burdens (mean scores 4.48 and 1.69, respectively) when compared with those who were not using CGM (mean score 4.19 and 2.35, respectively) ( P < .001). There were no differences in burdens or benefits by sex. Non-CGM users aged ≥50 years had higher mean BurCGM scores than those aged <50 years ( P = .004); the cost was the greatest barrier in those aged 27+ years. Other burdens were readings not trusted, painful to wear, and takes too much time to use. For those aged 65+, nonusers versus users, 18.5% versus 3.1% agreed with “it was too hard to understand CGM information,” and 21.4% versus 7.7% agreed that CGM causes too much worry. Mean HbA1C was lower in CGM users (8.1%) versus non-CGM users (mean A1c 9.1%; P < .001). Conclusions: CGM was perceived as having more burdens and less benefits in nonusers, with differences in concerns varying across the lifespan. Lower costs and age-appropriate education are needed to address these barriers.

Multi-Clinic Quality Improvement Initiative Increases Continuous Glucose Monitoring Use Among Adolescents and Young Adults With Type 1 Diabetes

“…Seven of the 10 participating centers experienced an increase in CGM use. All 10 sites performed assessments to identify barriers to CGM use in their clinics and designed interventions to address these barriers ( 15 ) and increase CGM use. Broadly, these interventions promoted CGM use to all patients, included discussion of CGM in the new-onset period, increased education to patients before and after CGM initiation, educated staff to promote CGM, and incorporated CGM prescribing and data review into clinical workflows.…”

“…Between May 2018 and March 2020, the 10 sites initially participating in the collaborative worked on improving CGM use among adolescents and young adults (12–26 years of age) from an aggregated baseline of 34% to a collaborative target of 50% over a 2-year time frame. Each center adapted preexisting barriers questionnaires ( 15 ) to assess barriers to CGM adoption in their populations and developed targeted interventions to address structural-, patient-, and provider-level barriers to CGM use.…”

Understanding the needs of people aging with type 1 diabetes: a user-focused research study with prototype diabetes advance directive and setting the stage for future research

“…For example, diabetes technology such as continuous glucose monitors, connected insulin pens, and insulin pumps can now provide real-time diabetes datasets [ 27 ] that can be shared with and interpreted by the patient’s care provider to help inform healthcare. While these technological resources have exponentially increased in its production and accessibility in recent years, it is critical to avoid the assumption that every patient with T1D has consistent access to these resources [ 28 ]. Moreover, it is important to recognize that each PWT1D has a unique level of interest and capacity to manage their disease.…”

Overcoming barriers to technology in special groups

“…Another reported barrier to CGM by individuals over 65 compared to those younger, is CGM data being ‘too hard to understand’; 49 however, extra support can overcome initial difficulties with data interpretation 48 …”