Demographic, Clinical, Psychosocial, and Behavioral Predictors of Continuous Glucose Monitor Use in Adults with Type 2 Diabetes

TL;DR

This study finds that younger age, insulin use, and higher socioeconomic status are key predictors of CGM use in adults with type 2 diabetes.

Contribution

Identifies novel psychosocial and behavioral predictors of CGM adoption in type 2 diabetes patients beyond clinical and demographic factors.

Findings

Younger age, insulin use, and higher socioeconomic status were significant predictors of CGM use.

Cost was the most common reason for discontinuing CGM use.

Diabetes self-care behaviors and self-efficacy did not significantly predict CGM use.

Abstract

Continuous glucose monitor (CGM) use is increasing rapidly among people with type 2 diabetes, although little is known about predictors of CGM use beyond clinical and demographic information available in electronic medical records. Behavioral and psychosocial characteristics may also predict CGM use.

We examined clinical, psychosocial, and behavioral characteristics that may predict CGM use in adults with type 2 diabetes.

This longitudinal observational study comprised a secondary analysis of data collected in a larger trial. Enrollment included HbA1c tests and surveys assessing demographic, clinical, psychosocial, and behavioral characteristics. We queried participants regarding their CGM use during the study on their final self-report surveys, 15 months post-enrollment.

Participants were 245 community-dwelling adults with type 2 diabetes recruited from primary care.

We used logistic regression to predict CGM use during the 15-month trial period from baseline characteristics.

Around one-third of participants (37.1%; 91/245) started CGM. Predictors of starting CGM in bivariate models included younger age, higher socioeconomic status, insulin use, higher HbA1c, and more diabetes distress. When including all potential predictors in a single multivariable model, only younger age (aOR = 0.95, p = 0.001), insulin use (aOR = 2.33, p = 0.006), and higher socioeconomic status (aOR = 0.44, p = 0.037) were significant predictors. Despite the association between higher HbA1c and CGM use, neither diabetes self-care behaviors nor diabetes self-efficacy significantly predicted CGM use. Of participants who tried a CGM, 14.3% (13/91) had stopped, with cost being the most-cited reason.

Even when including behavioral and psychological characteristics, younger age, using insulin, and higher socioeconomic status remain key predictors of CGM use. These findings emphasize the importance of access and affordability for people who may benefit from CGM. Providers should not bias their introduction of CGM towards those with (perceived or actual) optimal or sub-optimal self-care behaviors.