The Influence of Real-Time Continuous Glucose Monitoring on Psychosocial Outcomes in Insulin-Using Type 2 Diabetes

Abstract

Background: To examine the impact of real-time continuous glucose monitoring (rtCGM) on psychosocial outcomes in adults with insulin-using type 2 diabetes (T2D). Methods: A total of 174 insulin-using adults with T2D completed questionnaires assessing diabetes distress, hypoglycemic confidence, hypoglycemic fear, device-related emotional burden, and device-related trust before and after a six-month trial of rtCGM. Hemoglobin A1c (HbA1c) was assessed at the same time points; impaired hypoglycemic awareness (IAH) was assessed at baseline. Change in psychosocial outcomes was examined with t tests, then modeled as a function of baseline HbA1c and IAH and simultaneous change in HbA1c in multiple regression analyses. Results: Respondents were predominantly male (57.5%) and non-Hispanic white (67.8%). Significant improvement over the trial was observed in hypoglycemic fear ( P = .031), hypoglycemic confidence ( P < .001), diabetes distress ( P < .001), and device-related emotional burden ( P < .001). Impaired hypoglycemic awareness at baseline predicted greater improvement in hypoglycemic fear ( P = .002), hypoglycemic confidence ( P = .003), diabetes distress ( P = .013), and device-related emotional burden ( P < .001). Higher baseline HbA1c was linked with greater improvement in hypoglycemic fear ( P = .030); HbA1c change over the trial was positively associated with change in diabetes distress ( P = .010) and device-related emotional burden ( P = .003). Conclusions: Introduction of rtCGM in adults with insulin-using T2D was associated with significant improvements in diabetes-related psychosocial outcomes over six months. Gains were significantly greater among participants reporting IAH and those with higher HbA1c at baseline, thus providing the first evidence regarding which users might more likely benefit.