Real-time continuous glucose monitoring (rt-CGM) technology has much improved over the last few years, becoming more accurate and easier to use. Higher % of Time In glucose Range (TIR) and lower % of Time Below glucose Range (TBR) can be seen when rt-CGM is compared with intermittent scanning continuous glucose monitoring (is-CGM, a.k.a. Flash Glucose Monitoring) or when rt-CGM is combined with open-loop pump therapy (Sensor-Assisted Pump [SAP] therapy) or multiple daily injections (MDI). Integrating rt-CGM in more recent Automated Insulin Delivery (AID) systems (i.e. [advanced] Hybrid Closed-Loop [aHCL] systems) leads to even more optimal TIR and TBR values. This sensor technology has also been shown to benefit diabetes-related quality of life (QoL), although most existing studies have been either qualitative or quantitative and have not assessed if rt-CGM was used in the SAP or in the AID setting. In the Netherlands rt-CGM reimbursement is limited to certain categories of people with type 1 diabetes (PWDs), which has sparked a societal debate. This study, co-authored by Per Winterdijk, Henk-Jan Aanstoot and Giesje Nefs of Diabeter, aimed to get a detailed overview (quantitative and qualitative) of both positive and negative experiences of Dutch PWDs who are using rt-CGM technology and its impact on QoL.

In this cross-sectional, observational study ~8,000−10,000 eligible Dutch PWDs aged ≥18 years currently using rt-CGM were contacted via care and advocacy organizations: Bas van de Goor Foundation, Diabeter, Diabetes+, Diabetesvereniging Nederland, Dutch Diabetes Research Foundation, Sensorvergoeding.nl, Stichting DON, Stichting ééndiabetes, and Stichting JDRF Nederland. They received a link to the information folder, consent form and anonymous survey.

Key findings:

• Of 1,163 PWDs who consented, 893 were included, of whom 777 completed the full survey
• The age group 31−40 years was best represented (26%), 75% were female and the HbA1c 6.5−6.9% (lowest) group was best represented
• The biggest advantages of rt-CGM use were feelings of being:
  • less restricted by diabetes
  • more satisfied with diabetes management
• The most obvious disadvantages were constantly looking at glucose levels, sleep disruptions, excessive thinking about diabetes, RT-CGM not being as accurate as desired, skin irritations or bruises
• Users of AID systems reported a significantly larger improvement in overall QoL, fatigue and diabetes-specific distress than those using SAP or Open Loop
• Participants were very satisfied with being able to use rt-CGM, experiencing:
  • The feeling of being more like a person without diabetes due to decreased burden/ workload
  • Improved perceived personal control over diabetes
  • Increased sense of safety
  • Decreased discomfort due to lower frequency of finger-stick glucose measuring
• Many participants were dreading the moment they would have to change back to the ‘old ways’

Concluding, the authors state

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