Real-Time Continuous Glucose Monitoring in Type 1 Diabetes: A Qualitative Framework Analysis of Patient Narratives

Abstract

OBJECTIVEThis study analyzed narratives about experiences of real-time continuous glucose monitoring (CGM) in people with type 1 diabetes. RESEARCH DESIGN AND METHODSPeople with type 1 diabetes using CGM and caregivers completed an online survey. Questions included duration of CGM, frequency of sensor wear, funding, and a free narrative about experiences or views about CGM. We used qualitative framework analysis to analyze 100 responses; 50% of participants were aged ‡18 years. RESULTSMost participants (87%) used CGM with insulin pump therapy, 71% used sensors ‡75% of the time, and 66% received funding for CGM from the National Health Service. Four themes were identified: 1) metabolic control, 2) living with CGM (work and school, sleep, exercise, nutrition, frequency of self-monitoring of blood glucose [SMBG]), 3) psychological issues and patient/caregiver attitudes, and 4) barriers to CGM use (technical issues, financial issues, attitudes of healthcare professionals toward CGM). Despite some hassles, experiences were overwhelmingly positive, with improved glycemic control, diet and exercise management, quality of life, and physical and psychological well-being, as well as reduced frequency of SMBG. Technical problems included sensor inaccuracy and unreliability, and "alarm fatigue." The advantages of CGM used with an insulin pump with automatic suspension of insulin delivery during hypoglycemia were recorded by several participants, noting reduced hypoglycemia frequency and fear of nocturnal hypoglycemia. CONCLUSIONSPatient and caregiver narratives indicate that CGM is a valuable addition to diabetes care for many with type 1 diabetes.

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

“…Cost is the primary reason for CGM discontinuance in adults with T1D [19] and has been routinely identified as a barrier to CGM [11, 19, 29, 74, 75] and insulin pump use [76]. Distress related to not knowing if continuation of CGM use will be possible when financial difficulties arise also occurs [75]. Adolescents have reported being concerned about losing CGMs because it is expensive [69, 77].…”

Technology Use in Transition-Age Patients With Type 1 Diabetes

“…43 Surveys of both current and former CGM users illustrate perceived beneficial aspects such as improved sense of safety, motivation and confidence to manage diabetes, and avoidance of serious hypoglycemia but also report problems with accuracy, usability, intrusiveness, alarms, and insurance issues leading to inconsistent use or discontinuation altogether. [44][45][46] Device features and educational programs that succeed with younger children or older adults may fail in the transition-age group. Unfortunately there is still a paucity of literature specifically examining barriers to technology use and acceptance in transition-age youth.…”

Continuous Glucose Monitoring in the Real World Using Photosurveillance of #Dexcom on Instagram: Exploratory Mixed Methods Study (Preprint)

“…Recent research [18] indicates that CGM placement in areas of lipohypertrophy, which may not necessarily be on the abdomen, has equivalent or superior glucose accuracy to that of normal tissue; however, long-term data is lacking. Currently, 68-71% of CGM users wear their CGM at least 75% of the time [19,20], it is possible that use of off-label CGM locations may increase this number.…”