Patient, family, community, and health care system predictors of continuous glucose monitor use.

Abstract

Objective: Continuous glucose monitoring (CGM) systems can improve psychosocial and health outcomes among youth with type 1 diabetes (T1D). However, inconsistent use of CGM is common in youth and negates the clinical benefits of these devices. The current study sought to identify individual-, family-, community-and health care system-level predictors of greater CGM use in adolescents with T1D. Method: Adolescents with T1D (n = 66), ages 12-18 years, participated in a 3-month, prospective, observational study. Participants completed self-report questionnaires at baseline measuring individual (self-efficacy to manage T1D), family (collaborative parent involvement), community (diabetes-specific social support from friends), and health care system (insurance) predictor variables. Data on CGM use (i.e., number of days adolescents wore their CGM ≥ 12 hr) were collected monthly. Generalized linear mixed-effects models were used to examine associations between predictor variables and CGM use over time. Results: Adolescents (53% male, 83% white) averaged 15.03 years old (SD = 1.72 years), had an average glycated hemoglobin of 8.18% (SD = 1.89%), and used their CGM an average of 18.89 days each month (SD = 11.31). Self-efficacy to manage T1D was positively associated with CGM use (rate ratio = 1.21, p = .03). Collaborative parent involvement, diabetes-specific social support from friends, and type of insurance were not associated with CGM use. Conclusions: Greater self-efficacy predicted more CGM use. Interventions that bolster diabetes self-efficacy may help promote consistent CGM use. Future research should continue to examine predictors of CGM use from family, community, and health care system domains. Implications for Impact StatementResults from this study suggest that improving adolescents' self-efficacy in their ability to manage their diabetes can help them use continuous glucose monitoring (CGM) more consistently. Interventions that bolster self-efficacy, including diabetes selfmanagement education and coping skills training, may help adolescents who are struggling to use CGM more consistently. More research is needed to understand how family, community, and health care system variables affect CGM use.