Impact of glycaemic technologies on quality of life and related outcomes in adults with type 1 diabetes: A narrative review

Jane Speight; Pratik Choudhary; Emma G Wilmot; Christel Hendrieckx; Hannah Forde; Wai Yee Cheung; Thomas Crabtree; Bekki Millar; Gemma Traviss-Turner; Andrew Hill; Ramzi A Ajjan

doi:10.1111/dme.14944

Impact of glycaemic technologies on quality of life and related outcomes in adults with type 1 diabetes: A narrative review

Diabet Med. 2023 Jan;40(1):e14944. doi: 10.1111/dme.14944. Epub 2022 Sep 26.

Authors

Jane Speight^{1

2}, Pratik Choudhary³, Emma G Wilmot^{4

5}, Christel Hendrieckx^{1

2}, Hannah Forde³, Wai Yee Cheung⁶, Thomas Crabtree^{4

5}, Bekki Millar⁷, Gemma Traviss-Turner⁸, Andrew Hill⁸, Ramzi A Ajjan⁹

Affiliations

¹ School of Psychology, Deakin University, Geelong, Australia.
² The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia.
³ Diabetes Research Centre, University of Leicester, Leicester, UK.
⁴ Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK.
⁵ Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
⁶ Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK.
⁷ Diabetes Research Steering Group, Diabetes UK, London, UK.
⁸ Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
⁹ Leeds Institute of Cardiovascular and Metabolic Medicine, the LIGHT Laboratories, University of Leeds, Leeds, UK.

Abstract

Aims: To explore the association between the use of glycaemic technologies and person-reported outcomes (PROs) in adults with type 1 diabetes (T1D).

Methods: We included T1D and technology publications reporting on PROs since 2014. Only randomised controlled trials and cohort studies that used validated PRO measures (PROMs) were considered.

Results: T1D studies reported on a broad range of validated PROMs, mainly as secondary outcome measures. Most studies examined continuous glucose monitoring (CGM), intermittently scanned CGM (isCGM), and the role of continuous subcutaneous insulin infusion (CSII), including sensor-augmented CSII and closed loop systems. Generally, studies demonstrated a positive impact of technology on hypoglycaemia-specific and diabetes-specific PROs, including reduced fear of hypoglycaemia and diabetes distress, and greater satisfaction with diabetes treatment. In contrast, generic PROMs (including measures of health/functional status, emotional well-being, depressive symptoms, and sleep quality) were less likely to demonstrate improvements associated with the use of glycaemic technologies. Several studies showed contradictory findings, which may relate to study design, population and length of follow-up. Differences in PRO findings were apparent between randomised controlled trials and cohort studies, which may be due to different populations studied and/or disparity between trial and real-world conditions.

Conclusions: PROs are usually assessed as secondary outcomes in glycaemic technology studies. Hypoglycaemia-specific and diabetes-specific, but not generic, PROs show the benefits of glycaemic technologies, and deserve a more central role in future studies as well as routine clinical care.

Keywords: continuous glucose monitoring (CGM); insulin pump; intermittently scanned continuous glucose monitoring (isCGM); person-reported outcome measure (PROM); person-reported outcomes (PROs); quality of life (QoL); type 1 diabetes.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 1* / drug therapy
Humans
Hypoglycemia* / chemically induced
Hypoglycemia* / drug therapy
Hypoglycemia* / prevention & control
Hypoglycemic Agents / therapeutic use
Insulin / therapeutic use
Insulin Infusion Systems
Quality of Life
Randomized Controlled Trials as Topic
Technology

Substances

Blood Glucose
Hypoglycemic Agents
Insulin