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CGM may reduce perceived diabetes distress in adolescents with type 1 diabetes

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April 2, 2018

In adolescents with type 1 diabetes, use of a continuous glucose monitor, alone or in conjunction with insulin pump therapy, was associated with lower diabetes-related distress and lower HbA1c compared with no device use, according to study findings published in the Journal of Diabetes Science and Technology.

“Technology use in youth may be associated with lower [HbA1c], although the magnitude of this association needs further evaluation given recent technological advancements,” Anthony T. Vesco, PhD, a pediatric psychology fellow in the department of psychiatry and behavioral health at Ann and Robert H. Lurie Children’s Hospital of Chicago, and colleagues wrote. “Technology use may be associated with psychological benefits, or it may be associated with increased distress. A greater understanding of how diabetes technology is associated with diabetes-related psychological distress is needed.”

Vesco and colleagues analyzed data from 1,040 adolescents with type 1 diabetes (mean age, 14 years; 56.7% girls; 90.8% white) and their parents, recruited from diabetes camps throughout the U.S., who completed participant-specific questionnaires online about diabetes distress. Surveys completed included the Problem Areas in Diabetes (PAID) teen and parent scales, rating diabetes management and diabetes-specific emotional stress in everyday life on a scale of 1 (not a problem) to 6 (serious). Researchers obtained HbA1c via parent report and surveyed parents on whether teens used CGM or a standard blood glucose meter, and insulin via a pump or multiple daily injections, grouping teens into one of four groups: CGM alone (n = 19), pump therapy alone (n = 664), CGM plus pump therapy (n = 112) and no technology use (n = 245). Researchers used analysis of covariance with Games-Howell post hoc tests and Cohen’s d effect size (due to low sample size in the CGM-only group) to assess the mean differences among technology groups on adolescent- and parent-reported diabetes distress on HbA1c.

CGM use was associated with less adolescent distress when compared with teens who used no technology (d = 0.59), CGM plus pump therapy (d = 0.26) or pump therapy alone (d = 0.29), according to researchers. Group means for parent-reported distress showed a similar pattern, with parent distress lowest among those with teens using CGM alone and highest among those with teens not using technology (d = 0.05).

CGM use alone and CGM plus pump therapy was associated with the lowest mean HbA1c in teens, according to researchers, with negligible effect sizes between those two groups (d = 0.03). Teens in the no-technology group had the highest mean HbA1c, followed by teens using only pump therapy.

“About a 0.5% lower [HbA1c] is associated with CGM use over use of [pump therapy] alone, and this difference is even larger when comparing CGM use to use of no technology; findings of the current study do not support a significant additive difference in [HbA1c] associated with using CGM plus [pump therapy],” the researchers wrote. “Given that an absolute increase of 1% in [HbA1c] standard deviation is linked with increased risks for retinopathy and neuropathy, current results are clinically significant.”

Within the cohort, 41% of teens scored above the empirically derived clinical cutoff score for the PAID-T scale ( 44; 14 items, with higher scores indicating higher diabetes distress). Most teens scoring above the PAID-T threshold were in the no-technology group (52.8%), followed by the CGM plus pump therapy group (37.9%), the pump therapy alone group (37.5%) and the CGM alone group (33.3%).

“CGM alone had the lowest proportion of clinical elevation among the groups, but statistical significance from ‘no technology’ was likely not achieved due to low sample size,” the researchers wrote.

The researchers noted that interpretation of the findings is bidirectional: CGM use may decrease diabetes distress and HbA1c, or, lower diabetes distress and a lower HbA1c may predict CGM use. – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.