Continuous glucose monitoring empowers adolescents to take responsibility of diabetes management

Abstract

Background: Managing diabetes is especially challenging for adolescents, and they often struggle to believe they can manage the condition. Illness perception has been widely associated with better diabetes management outcomes, but the influence of continuous glucose monitoring (CGM) on adolescents has been largely neglected.Aim: The study aimed to explore the illness perception of a group of adolescents living with type 1 diabetes (T1D) using CGM.Setting: The study was conducted at a medical centre that provides diabetes care services to youth living with T1D in Parktown, South Africa.Methods: A qualitative research approach using semi-structured online interviews was used to gather data that was thematically analysed.Results: Themes emerging from the data confirmed that CGM creates a sense of control over diabetes management as blood glucose measures were more visible. A sense of normalcy was established as CGM influences a new routine and a way of life, integrating diabetes into a young person’s identity. Despite the users’ awareness of being different due to diabetes management, CGM assisted in creating a sense of belonging, contributing to developing a better quality of life.Conclusion: Findings of this study support the use of CGM as a means of empowering adolescents struggling with diabetes management to achieve better treatment outcomes. The important role of illness perception in facilitating this change was also evident.Contribution: By listening to the adolescent’s voice, CGM was identified as a possible intervention to empower adolescents to improve diabetes management.

Smile with diabetes: reflections on illness perception and diabetes management behaviors of adolescents in private health care in South Africa

“…Adjusting to diabetes happens over time, just as developing an identity does. Oris and colleagues (32) identified four phases of identity development, which was evident in the adolescent participants in the various studies reviewed here: engulfment was evident in all groups as they reported being overwhelmed by the initial diagnosis (6,29,30); rejection of diabetes as part of their lives was evident in the uncontrolled group (6); acceptance was seen in the wellcontrolled and CGM groups (29,30); and enrichment was seen also in the well-controlled and CGM groups (29,30). The differences in identity development among the well-controlled and uncontrolled groups imply that teaching adolescents to think more like the wellcontrolled group could be beneficial, and that the use of CGM empowers not only diabetes management but potentially also identity development in adolescents living with type 1 diabetes.…”

“…The effect of beliefs about the consequences of diabetes, as well as beliefs in its control, underlaid themes 3 and 4 and the discussion above. The differences in personal control are important to note: those who managed diabetes well and those using CGM were empowered by positive feedback, which gave them confidence in managing the condition (29,30), even when they struggled. Adolescents in these groups held strong beliefs about personal control, although the control of treatment may not have been effective.…”

“…All participants actively sought situations in which they could feel "normal" and belong to a group, such as a sports team (6,29,30). For adolescents using CGM, being different and wearing a CGM device also provided opportunities to reach out to others using the equipment and creating a feeling of belonging; as one participants noted, she "gets excited" when she sees someone else wearing a CGM (30).…”

“…It is important to note that CGM assists in incorporating diabetes management into one's identity ("made it seem less like a disability" (30)) and hence can be seen as a medical intervention not only to improve psychical outcomes but also assisting in identity integration as CGM became an integral "part of myself" (30) and the participant's way of life.…”

“…It was noteworthy that all participants in the studies reported on the unpredictability of diabetes and how it requires different actions to be taken; but all those with the condition well-controlled and those using CGM still believed that diabetes is manageable. Where differences of opinion existed, they could be explained by adolescents lacking control giving up because they felt that they could not manage their situation, whereas those exercising good control and using CGM were empowered by their sense of achievement and even experiencing positive outcomes, such as growth (30). These themes are summarized in Table 1.…”