Introduction and Objective: A recent randomized controlled trial demonstrated greater improvements in patient-reported engagement with diabetes self-care and glycemic control in new Freestyle Libre 3 (FSL3) users than standard glucose monitor users. We aimed to qualitatively explore how continuous glucose monitoring (CGM) led to these behavioral and glycemic changes.Methods: Adults with T2D on basal or non-insulin treatment in the FSL3 arm of the RCT were invited to complete in-depth semi-structured interviews at study end (3 months). Interview questions focused on the impact of CGM on diabetes-related attitudes, changes in quality of life and lifestyle behaviors, and post-CGM changes, and were refined as themes emerged. Thematic analysis was employed to identify, analyze, and interpret attitudinal and behavioral patterns, using a combined inductive and deductive approach. A coding system was developed; 2 independent reviewers coded each interview, and a 3rd party reviewed disparities until consensus was reached.Results: Thirty-one participants were interviewed (67% of FSL3 study arm). Key attitudinal changes resulting from CGM use included: T2D now seeming more “real” or “visible” (n=29, 94%), effective decision-making now seeming more possible (n=21, 68%), and enhanced self-efficacy (n=20, 65%). Of note, enhanced self-efficacy was associated with positive HbA1c change over the study period (p=.02). Key CGM-induced behavioral changes included marked improvements in diet (n=26, 84%), physical activity (n=11, 35%), and medication use (n=6, 19%). At study end, almost all participants (n=29, 94%) were interested in continuing CGM, but n=23 (74%) reported they could not do so, primarily due to cost concerns; of this latter group, 12 (52%) reported regressing to pre-study behaviors.Conclusion: These findings provide critical insight into how FSL3 can positively impact engagement with diabetes self-management and glycemic control, and highlight the importance of continuing to ensure broad access to CGM technology.
W.H. Polonsky: Consultant; Abbott. Research Support; Abbott. Consultant; Dexcom, Inc. Research Support; Dexcom, Inc. Other Relationship; Ascensia Diabetes Care. T. Clark: None. E.C. Soriano: None. M. Chichmarenko: None. H. Sandoval: None. A. Bastian: None. A.L. Fortmann: None. A. Kwist: Employee; Abbott. F. Levrat-Guillen: Employee; Abbott.
This study was funded by Abbott
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