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Treatment Satisfaction and Well-Being With CGM in People With T1D: An Analysis Based on the GOLD Randomized Trial
Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
Behav Diabet Inst, CA USA; Univ Calif San Diego, CA USA.
Chalmers Univ Technol, Sweden; Univ Gothenburg, Sweden; Statist Konsultgruppen, Sweden.
Centralsjukhuset, Sweden.
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2023 (English)In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM. Methods: The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R-2-decomposition was used to understand which variables contributed most to treatment satisfaction. Results: A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress. Conclusions: While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC , 2023.
Keywords [en]
CGMS; MDI; quality of life; SMBG; treatment satisfaction; type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:liu:diva-196631DOI: 10.1177/19322968231183974ISI: 001036259300001PubMedID: 37501366OAI: oai:DiVA.org:liu-196631DiVA, id: diva2:1788678
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2023-08-16

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Wijkman, Magnus
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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Internal Medicine in Norrköping
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