Continuous Glucose Monitoring (CGM) Adherence in Youth With Type 1 Diabetes: Associations With Biomedical and Psychosocial Variables.
Continuous glucose monitoring (CGM) remains underutilized in youth with type 1 diabetes (T1D). There is a need to investigate factors associated with CGM use.



In 61 T1D youth, CGM use was ascertained by downloads reflecting the 4-week periods preceding 3- and 6-month study visits. Demographic and clinical data were obtained from chart review and interview. Youth and parents completed validated psychosocial surveys at baseline and 6 months.



Youth (52% male, 93% Caucasian, 80% pump treated) were 12.7 ± 2.9 years old, with T1D for 6.3 ± 3.8 years; mean A1c was 7.9 ± 0.9%. Mean CGM use was 4.1 ± 2.1 days/week (median = 4.8) at 3 months and 3.4 ± 2.3 days/week (median = 3.9) at 6 months. At 3 and 6 months, 15% and 20% of youth, respectively, had stopped using CGM. At 6 months, youth using CGM 6-7 days/week had more frequent BG monitoring ( P = .05), less insulin omission ( P = .02), and greater probability of A1c < 7.5% ( P = .01) than youth using CGM less often. Youth using CGM 6-7 days/week consistently over the 6 months demonstrated lower A1c at 3 months compared to baseline ( P = .03) and the improvement was sustained at 6 months ( P = .5, 3 vs 6 months); youth using CGM less often had no significant A1c change. Baseline BG monitoring ≥8 times/day or A1c within target (<7.5%) predicted greater CGM use (6-7 days/week) at 6 months (OR = 4.6, P = .02). There was no deterioration of psychosocial functioning with CGM use.



Consistent and durable CGM use in youth with T1D is associated with treatment adherence and improved glycemic control without increasing psychosocial distress.
1 Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.|2 Department of Pediatrics, Section on Pediatric Endocrinology, Diabetes and Metabolism, Biomedical and Clinical Science Department, V. Buzzi Children's Hospital, University of Milan, Milan, Italy.
Elisa
E
Giani
1 Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Rebecca
R
Snelgrove
1 Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Lisa K
LK
Volkening
1 Pediatric, Adolescent and Young Adult Section, Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
Lori M
LM
Laffel
D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1; D005260:Female; D005947:Glucose / Q000032:analysis; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods* / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D011584:Psychology
D005947:Glucose
adherence; continuous glucose monitoring; pediatrics; psychosocial factors; type 1 diabetes