• Can Continuous Glucose Monitoring Impact Diabetes Distress?

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    It is known that the majority of patients with diabetes are managed in primary care.1 But did you know that diabetes distress is more common than clinical depression among people living with diabetes?2 Between 30% and 40% of adults with diabetes are likely to report significant levels of diabetes distress over time.2 And greater diabetes distress is associated with adverse outcomes, including elevated A1C and an increased fear of hypoglycemia.2,3 Diabetes distress is the emotional response to living with diabetes, bearing the burden of chronic and demanding diabetes self-management, and facing the prospect of diabetes-related complications.2,3

    How can family physicians address distress in patients who have diabetes? Real-time continuous glucose monitoring (RT-CGM) is associated with a significantly greater reduction in diabetes distress and improvement in self-reported hypoglycemia confidence in adults with type 1 diabetes on multiple daily insulin injections compared to self-monitoring of blood glucose.4 Notably, RT-CGM has also been shown to significantly decrease regimen distress and interpersonal distress.* For the adolescent population, continuous glucose monitor (CGM) use was associated with less adolescent distress compared to the use of no technology.5

    Advances in RT-CGM provide the opportunity for real-time data sharing with the user’s personal network (e.g., family, friends). The selected followers can be alerted if the user’s glucose reaches certain thresholds, such as severe hypoglycemia and hyperglycemia. Real-time data-sharing features have contributed to improved hypoglycemic confidence, improved overall well-being and quality of life, and reduction in diabetes distress in adults and older adults.6,7

    As diabetes distress is relatively common and can impact self-management, it is important that family physicians consider the use of RT-CGM as an option to address diabetes-specific quality of life measures.6,7 Watch 4 short videos by Mark Heyman, PhD, a psychologist and certified diabetes care and education specialist who lives with type 1 diabetes, to get practical tips on diabetes and issues around mental health and diabetes distress.

    These videos will discuss:

    • Navigating the stress of diabetes: Learn how you can help your patients overcome the stressful times of diabetes.

    • Diabetes burnout: Prepare your patients with these suggestions when diabetes burnout hits.

    • Fear of hypoglycemia: Discover how diabetes technology can increase your patients’ confidence to act.

    • Boundaries around diabetes in relationships: Help your patients set clear boundaries in their relationships.

    *Regimen distress focuses on daily disease management. Interpersonal distress involves the feeling that friends or family are not supportive enough of self-care efforts.

    References

    1. Zoberi KA, Salas J, et al. Comparison of Family Medicine and General Internal Medicine on Diabetes Management. Mo Med. 2017;114(3):187-194.
    2. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Distress and Depression. January 8, 2020. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/diabetes-distress-and-depression#:~:text=Diabetes%20distress%20is%20much%20more,of%20diabetes%20distress%20over%20time. Accessed May 25, 2022.
    3. American Diabetes Association. Chapter 3. Diabetes Distress. https://professional.diabetes.org/sites/professional.diabetes.org/files/media/ada_mental_health_workbook_chapter_3.pdf. Accessed May 25, 2022.
    4. Polonsky WH, Hessler D, et al. The Impact of Continuous Glucose Monitoring on Markers of Quality of Life in Adults With Type 1 Diabetes: Further Findings From the DIAMOND Randomized Clinical Trial. Diabetes Care. 2017; 40 (6): 736-741.
    5. Vesco AT, Jedraszko AM, et ak. Continuous Glucose Monitoring Associated With Less Diabetes-Specific Emotional Distress and Lower A1c Among Adolescents With Type 1 Diabetes. J Diabetes Sci Technol. 2018;12(4):792-799.
    6. Polonsky WH, Fortmann AL. Impact of Real-Time Continuous Glucose Monitoring Data Sharing on Quality of Life and Health Outcomes in Adults with Type 1 Diabetes. Diabetes Technol Ther. 2021;23(3):195-202.
    7. Allen NA, Litchman ML, et al. Continuous Glucose Monitoring Data Sharing in Older Adults With Type 1 Diabetes: Pilot Intervention Study. JMIR Diabetes. 2022;7(1):e35687.

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