Abstract
Background and Aims
Little is known about the optimal timing of CGM initiation in youth with type 1 diabetes (T1D). This pilot randomized controlled trial examined differences in glycemic and psychosocial outcomes between youth with T1D and their caregivers who started CGM soon after diagnosis compared to those starting CGM 6 months later.
Methods
Data from 55 study participants (ages 2-17 years, mean age 11.1±3.6 years, 50% female, 69% non-Hispanic white) and their caregivers were collected at initiation of CGM and again 6 months later. Participants were randomized 2:1 to early CGM start (n=42, 24±7 days), or delayed start (n=13, 204±11 days). Caregivers completed online validated surveys about their diabetes-related distress, technology attitudes, and glucose monitoring satisfaction.
Results
Pearson correlations showed that more time between diagnosis of T1D and CGM start was associated with higher levels of CGM discontinuation (r=0.37, p=0.005), lower CGM use over the six-month period (r=0.41, p=0.002), higher levels of diabetes distress among parents (r=0.27, p=0.05), and more time spent under 54 mg/dL (r=0.27, p=0.05). Time to CGM start was not correlated with HbA1c values following 6 months of CGM use. T-tests showed that parents of youth who discontinued CGM (n=6) had less positive technology attitudes (p=0.003) and felt more restricted by glucose monitoring (p=0.02), but experienced less sleep disturbance (p=0.002) than parents of youth using CGM over the six-month period.
Conclusions
Despite similar glycemic results, starting CGM closer to diagnosis of T1D in youth is correlated with higher sustained use by youth and less diabetes distress for caregivers.
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