Real-time continuous glucose monitoring among participants in the T1D Exchange clinic registry

• Published in: Diabetes care Vol. 37; no. 10; pp. 2702 - 2709
• Main Authors: Wong, Jenise C, Foster, Nicole C, Maahs, David M, Raghinaru, Dan, Bergenstal, Richard M, Ahmann, Andrew J, Peters, Anne L, Bode, Bruce W, Aleppo, Grazia, Hirsch, Irl B, Kleis, Lora, Chase, H Peter, DuBose, Stephanie N, Miller, Kellee M, Beck, Roy W, Adi, Saleh
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01-10-2014
• Subjects: Adolescent; Adult; Blood Glucose - metabolism; Blood Glucose Self-Monitoring - methods; Child; Clinical Care/Education/Nutrition/Psychosocial Research; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetic Ketoacidosis - epidemiology; Female; Glucose; Glycated Hemoglobin A - analysis; Humans; Hypoglycemia; Hypoglycemia - epidemiology; Incidence; Insulin - administration & dosage; Insulin - therapeutic use; Insulin Infusion Systems; Male; Medical treatment; Monitoring, Ambulatory - utilization; Patient Education as Topic; Registries; Retrospective Studies; Risk Factors; Teenagers; Young Adult
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc14-0303

To assess the frequency of continuous glucose monitoring (CGM) device use, factors associated with its use, and the relationship of CGM with diabetes outcomes (HbA1c, severe hypoglycemia [SH], and diabetic ketoacidosis [DKA]).
Survey questions related to CGM device use 1 year after enrollment in the T1D Exchange clinic registry were completed by 17,317 participants. Participants were defined as CGM users if they indicated using real-time CGM during the prior 30 days.
Nine percent of participants used CGM (6% of children <13 years old, 4% of adolescents 13 to <18 years, 6% of young adults 18 to <26 years, and 21% of adults ≥26 years). CGM use was more likely with higher education, higher household income, private health insurance, longer duration of diabetes, and use of insulin pump (P < 0.01 all factors). CGM use was associated with lower HbA1c in children (8.3% vs. 8.6%, P < 0.001) and adults (7.7% vs. 7.9%, P < 0.001). In adults, more frequent use of CGM (≥6 days/week) was associated with lower mean HbA1c. Only 27% of users downloaded data from their device at least once per month, and ≤15% of users reported downloading their device at least weekly. Among participants who used CGM at baseline, 41% had discontinued within 1 year.
CGM use is uncommon but associated with lower HbA1c in some age-groups, especially when used more frequently. Factors associated with discontinuation and infrequent use of retrospective analysis of CGM data should be considered in developing next-generation devices and education on CGM use.