Impact of continuous glucose monitoring on quality of life, treatment satisfaction, and use of medical care resources: analyses from the SWITCH study

Abstract

To investigate the impact of continuous glucose monitoring (CGM) on health-related quality of life (HRQOL), treatment satisfaction (TS) medical resource use, and indirect costs in the SWITCH study. SWITCH was a multicentre, randomized, crossover study. Patients with type 1 diabetes (n = 153) using continuous subcutaneous insulin infusion (CSII) were randomized to a 12 month sensor-On/Off or sensor-Off/On sequence (6 months each treatment), with a 4-month washout between periods. HRQOL in children and TS in adults were measured using validated questionnaires. Medical resource utilization data were collected. In adults, TS was significantly higher in the sensor-On arm, and there were significant improvements in ratings for treatment convenience and flexibility. There were no clinically significant differences in children’s HRQOL or parents’ proxy ratings. The incidence of severe hypoglycaemia, unscheduled visits, or diabetes-related hospitalizations did not differ significantly between the two arms. Adult patients made fewer telephone consultations during the sensor-On arm; children’s caregivers made similar numbers of telephone consultations during both arms, and calls were on average only 3 min longer during the sensor-On arm. Regarding indirect costs, children with >70 % sensor usage missed fewer school days, compared with the sensor-Off arm (P = 0.0046) but there was no significant difference in the adults days of work off. The addition of CGM to CSII resulted in better metabolic control without imposing an additional burden on the patient or increased medical resource use, and offered the potential for cost offsets.

Continuous Glucose Monitoring Use in Type 1 Diabetes: Longitudinal Analysis Demonstrates Meaningful Improvements in HbA1c and Reductions in Health Care Utilization

“…7,14,[18][19][20][21] However, recent evidence suggests that rtCGM use in conjunction with MDI treatment may provide the similar glycemic benefits without the additional costs associated with CSII therapy. 22 Our study found that use of rtCGM was associated with reduced HbA1c and utilization of health services compared with SMBG use regardless of insulin delivery method.…”

5. Glycemic Targets

“…A registry study of 17,317 participants confirmed that more frequent CGM use is associated with lower A1C (16), whereas another study showed that children with .70% sensor use missed fewer school days (17). Small randomized controlled trials in adults and children with baseline A1C 7.0-7.5% (53-58 mmol/mol) have confirmed favorable outcomes (A1C and hypoglycemia occurrence) in groups using CGM, suggesting that CGM may provide further benefit for individuals with type 1 diabetes who already have tight control (18,19).…”

Influences on Technology Use and Efficacy in Type 1 Diabetes

“…60 This is reassuring as there have been concerns that CGM data overload could have negative effects on QOL. 63,64 However its impact varies with age group, with trait anxiety higher in adolescents and lower in adults using CGM, compared with SMBG alone, 65 suggesting that CGM data may feel overwhelming in adolescents but empowering in adults.…”

“…62 Responders were also more likely than nonresponders to report their partner was interested in their CGM. 62 Several studies reported no QOL differences with SAPT, 57,61,63 but others found that SAPT improved diabetesspecific HRQOL (Hypoglycaemia Fear Survey Worry and Behaviour subscales) 58,59 and health and social functioning. 60 This is reassuring as there have been concerns that CGM data overload could have negative effects on QOL.…”