Patients' and caregivers' experiences of using continuous glucose monitoring to support diabetes self-management: qualitative study.
BACKGROUND
Continuous glucose monitoring (CGM) enables users to view real-time interstitial glucose readings and provides information on the direction and rate of change of blood glucose levels. Users can also access historical data to inform treatment decisions. While the clinical and psychological benefits of CGM are well established, little is known about how individuals use CGM to inform diabetes self-management. We explored participants' experiences of using CGM in order to provide recommendations for supporting individuals to make optimal use of this technology.


METHODS
In-depth interviews (n = 24) with adults, adolescents and parents who had used CGM for ≥4 weeks; data were analysed thematically.


RESULTS
Participants found CGM an empowering tool because they could access blood glucose data effortlessly, and trend arrows enabled them to see whether blood glucose was rising or dropping and at what speed. This predicative information aided short-term lifestyle planning and enabled individuals to take action to prevent hypoglycaemia and hyperglycaemia. Having easy access to blood glucose data on a continuous basis also allowed participants to develop a better understanding of how insulin, activity and food impacted on blood glucose. This understanding was described as motivating individuals to make dietary changes and break cycles of over-treating hypoglycaemia and hyperglycaemia. Participants also described how historical CGM data provided a more nuanced picture of blood glucose control than was possible with blood glucose self-monitoring and, hence, better information to inform changes to background insulin doses and mealtime ratios. However, while participants expressed confidence making immediate adjustments to insulin and lifestyle to address impending hypoglycaemia and hypoglycaemia, most described needing and expecting health professionals to interpret historical CGM data and determine changes to background insulin doses and mealtime ratios. While alarms could reinforce a sense of hypoglycaemic safety, some individuals expressed ambivalent views, especially those who perceived alarms as signalling personal failure to achieve optimal glycaemic control.


CONCLUSIONS
CGM can be an empowering and motivational tool which enables participants to fine-tune and optimize their blood glucose control. However, individuals may benefit from psycho-social education, training and/or technological support to make optimal use of CGM data and use alarms appropriately.
['Lawton|J|J|', 'Blackburn|M|M|', 'Allen|J|J|', 'Campbell|F|F|', 'Elleri|D|D|', 'Leelarathna|L|L|', 'Rankin|D|D|', 'Tauschmann|M|M|', 'Thabit|H|H|', 'Hovorka|R|R|']
D000293:Adolescent D000328:Adult D000368:Aged D015190:Blood Glucose Self-Monitoring D017028:Caregivers D003922:Diabetes Mellitus, Type 1 D005260:Female D005500:Follow-Up Studies D006442:Glycated Hemoglobin A D006801:Humans D006943:Hyperglycemia D007003:Hypoglycemia D008297:Male D008875:Middle Aged D010290:Parents D036301:Qualitative Research D011788:Quality of Life D000073278:Self-Management D055815:Young Adult
Continuous glucose monitoring Qualitative Caregiver experience Patient experience Type 1 diabetes