Psychosocial factors associated with use of continuous glucose monitoring.
OBJECTIVE
To identify psychosocial factors associated with the use of continuous glucose monitoring by adults with Type 1 diabetes.


METHODS
Twenty adult patients (aged 45 +/- 15 years, diabetes duration 25 +/- 19 years, 50% female) followed at our site in the multi-centre Juvenile Diabetes Research Foundation continuous glucose monitoring trial were divided into three groups: Glycated haemoglobin (HbA(1c)) Responders who demonstrated an improvement in glycaemic control with continuous glucose monitoring (baseline HbA(1c)> or = 7.0%, HbA(1c) reduction greater than or equal to 0.5%), Hypoglycaemia Responders (baseline HbA(1c) < 7.0%) who demonstrated decreased time < 3.9 mmol/l while remaining within target HbA(1c), and HbA(1c) Non-Responders (baseline HbA(1c)> or = 7.0%, HbA(1c) reduction less than 0.5%). Subjects participated in semi-structured interviews focusing on their psychosocial experiences with continuous glucose monitoring.


RESULTS
Three major themes were identified that differentiated Responders (including both the HbA(1c) and Hypoglycaemia groups) from Non-Responders: (i) coping with frustrations-Responders used self-controlled rather than emotions-based coping when faced with continuous glucose monitoring frustrations; (ii) use of information-Responders used retrospective pattern analysis, not just minute-by-minute data analysis, in glycaemic management; (iii) 'significant other'/spousal involvement-Responders endorsed interest, encouragement and participation by their loved ones. Both Responders and Non-Responders expressed body image concerns when wearing continuous glucose monitoring devices.


CONCLUSIONS
This qualitative study points to the importance of coping skills, retrospective review of data, and 'significant other' involvement in the effective use of continuous glucose monitoring. These findings will inform clinical initiatives to improve patient selection and training in the use of this new technology and have served as the basis for development of quantitative surveys to be used in clinical practice.
Ritholz
M D
MD
Joslin Diabetes Center, Boston, MA 02215, USA. Marilyn.Ritholz@joslin.harvard.edu
Atakov-Castillo
A
A
Beste
M
M
Beverly
E A
EA
Leighton
A
A
Weinger
K
K
Wolpert
H
H
D000328:Adult; D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000379:methods / Q000523:psychology*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000295:instrumentation / Q000523:psychology*; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000523:psychology*; D015337:Multicenter Studies as Topic; D010349:Patient Compliance
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin