Neutral Findings Predominate German Study of CGM Use

Treatment satisfaction has been very high and hemoglobin A1C (HbA1C) levels have been lowered following the move by German health insurance companies in 2016 to reimburse patients with insulin-dependent diabetes for their continuous glucose monitors (CGMs).

These survey findings, and others, were published in a recent issue of Journal of Diabetes Science and Technology, following anonymous administration of a survey during the 4-day nationwide youth diabetes camp, Camp D, in 2018.

In addition to their principal conclusion, the study investigators also found that neither diabetes distress, as measured via the Problem Areas in Diabetes Scale (PAID)-5, or glycemic control were improved. Each question of the PAID-5 is graded on a scale from 0 (not a problem) to 4 (serious problem).

“A high level of satisfaction with CGM use was shown in various clinical trials and qualitative studies, especially in patients with a high risk of hypoglycemia,” the authors explained. “However, most of these studies focused on adults with diabetes or parents of children with diabetes. Surveys of adolescents and young adults are still rare.”

Among the entire study cohort of 308 patients, 141 (46%) reported intermittent-scanning continuous glucose monitoring (iscCGM); 91 (30%), real-time continuous glucose monitoring (rtCGM); and 76 (24%), self-monitoring of blood glucose (SMBG). Most participants were female and older than 20 years. Overall, the mean (SD) age was 21.4 (3.5) years, mean diabetes duration was 10.1 (5.9) years, most (61%) used an insulin pump, mean HbA1C was 7.7% (1.5%), and mean PAID-5 score was 6.15 (4.42).

Insulin pump use was greatest among rtCGM users, followed by iscCGM and SMBG users, at 80%, 57%, and 43%, respectively. In addition, rtCGM users were older (P = .005) and had received their diabetes diagnosis the farthest back (P < .001). Fifty-five percent of the entire cohort met the HbA1C target of less than 7.5% (58 mmol/mol), and younger age (P < .001), greater distress (P < .001), and longer diabetes duration (P = .033) exerted the greatest influence on this outcome.

Following administration of the PAID-5, females reported greater distress vs males; the mean scores were 6.72 (4.45) and 4.57 (3.94), respectively. PAID-5 scores were also close to equal among SMBG (5.64 [4.75]), iscCGM (6.23 [4.04]), and rtCGM (6.43 [4.72]) users (P = .386). Further, more than a third (35%) had a total score of 8 or higher, “indicating an elevated level of diabetes distress,” the authors wrote, and this finding was independent of type of glucose monitoring (P = .823).

Following evaluation of CGM satisfaction—with opinions solicited on such items as feelings of security, impact on sleep, easy to use, and adequacy of alarms—98% self-reported an improvement to their overall well-being compared with SMBG. Few analyzed their CGM data on a regular basis; just 19% reported doing so, and 12% said they never did. Mean HbA1C was a half percentage point lower, however, among that 19% vs all of the other groups combined: 7.2% (1.2% [55.19 [10.38 mmol/mol]) vs 7.7% (1.4% [60.66 ± 8.2 mmol/mol]); P = .039). Age was the only factor to exert influence on this outcome (P = .02).

The study investigators expressed worry that so few analyzed their data on a regular basis; in particular, that 50% did not analyze their data self-reliantly. With their findings also showing greater use of CGM with older age, they posit that younger patients may need more support on how to use continuous glucose monitors via education and training.

They concluded that because technology can only reduce some of the diabetes burden, and that “further research is needed to examine interpersonal factors that may improve psychological well-being and clinical outcome through technology use. These studies would be essential for developing individually tailored treatment options to optimize young people’s technology use.”

Reference

Huhn F, Lange K, Jördening M, Ernst G. Real-world use of continuous glucose monitoring (CGM) systems among adolescents and young adults with type 1 diabetes: reduced burden, but little interest in data analysis. J Diabetes Sci Technol. Published online March 7, 2022. doi:10.1177/19322968221081216