#ATTD2022 – CGM Top Tips – Balancing the Benefit/Burden Seesaw

The Advanced Treatments and Technologies for Diabetes 2022 had many amazing sessions. In this blog post we will review the discussion around diabetes technology and how one size fits nobody. Each person living with diabetes has their own life style and challenges to overcome, so we need individual solution to improve our personal quality of life.

It is so important to see professors and healthcare professionals discuss not only the cheapest, easiest option to deal with the disease, but are starting to support the person living with diabetes. This is what patient and advocacy groups have been discussing amongst themselves for a while, so it is good to see it has reached the industry professionals as well. This sort of awareness and practice will hopefully make its way to all healthcare professionals across the globe, which will help more people live an active and healthy life with diabetes.

In this seminar, Professor Katharine Barnard-Kelly spoke about the benefits and burdens of cgms.

As amazing as these technologies are at improving glycemic control, time in range and enhancing the therapeutic experience for people living with diabetes, the huge mental burden of these devices, technologies and therapies are often underappreciated. This can make it difficult for patients. When healthcare professionals see optimal Time in Range, they assume there is also optimal quality of life and control, thus looking at the disease more than the patient. The burden and anxiety, the stress of chasing these numbers are a big part of living with diabetes.

There are of course both benefits and burdens to diabetes technology use. There are several studies showing improved HbA1C, more time in range, people are able to respond quicker to hypos and actual hypo awareness also often improves. People can identify patterns of behaviour, can see their spikes or drops and adjust basal rates accordingly to accomodate for these patterns. Overall, thanks to seeing trends, patients can respond better and quicker.

Despite the benefits, there are also burdens to consider. There are both physical as well as psychological burdens that need to be considered.

Some people report rashes, skin problems, stickers don’t stay on or they stick too well.

There can also be anxiety about glycemic control, since we can see when our blood sugar is out of range, it forces people to respond more quickly, which often leads to a yo-yo effect. Often there is a rapid response rather than having the confidence to wait and see where the trend goes.

The visibility of diabetes devices can also be a huge burden for some people. The social stigma associated with diabetes when devices are seen, the alarms, anything that draws attention to diabetes can be really troublesome for some people.

Professor Barnard-Kelly is urging healthcare professionals that it is necessary to find a way for each patient that optimizes glycemic control, improve quality of life and minimise the burden of living with diabetes.

However each aspect of a cgm is like a double-edged sword – what are benefits to some people are huge burdens for other people.

Improved awareness of trends and patterns can be good, people can be more bold in their choices and see the impact their actions have, but it can also lead to greater anxiety, feeling of hopelessness and despair. People feel they need to keep checking, that nothing seems to be working or that management is constantly the only thing they should worry about.

In a medical model of healthcare where the emphasis is firmly on biomedical outcomes, these psychological burdens are often neglected. But there is now an increasing willingness and attempt by healthcare professionals to be more psychosocially mindful in the routine care they offer to their patients. This is so important, because the reality is:

A biopsychosocial model of healthcare is needed for optimal conditions to manage lifelong condition like diabetes, not only for type 1 but all types of diabetes.

Other features of cgms have the same issues – alarms can save lives, but can also irritate people, make them feel isolated or embarrassed and they worry about their ability to take part in activities in case their alarm goes off during meetings. It can lead to snidy comments for teenagers in school, overcaring coworkers or a feeling of constantly interrupting people. It is therefore important that healthcare professionals have a meaningful conversation with their patients to discuss which alarms are necessary for optimum quality of life for each individual and how they are managing their diabetes.

Another aspect to consider is share facilities of cgms, which can be helpful for family and friends, but can also be misuses and give the person a feeling of being judged more. When share facilities are set up, it should be clearly discussed with the patient and it should be communicated what they want anyone to do or how they want the people with access to their levels to respond. If family members respond too quickly before the person living with diabetes has had a chance to address their low or high, it can lead to a feeling of not being trusted. People living with diabetes need time to react and respond first by themselves before outside people are trying to intervene. This however should be clearly discussed and communicated with each person who has access – at what point help is needed and what would feel too much like an invasion.

Frequency of attention to diabetes technology should also be discussed, so that there can be a balance between noticing trends and being able to react, without the stress and anxiety caused by checking too often, as well as the yo-yo effect that can happen by responding too quickly.

Knowing why each person wants a cgm can help, as alarms and share facilities can be set up to suit each person’s lifestyle and management better. People living with diabetes also need to be clear about what they want from their device to reduce stress and disappointment.

Some of the top tips professor Barnard-Kelly recommends are here:

Diabetes care is personal and individual, because each person is different, each person’s quality of life depends on something personal to them. We shouldn’t live our lives to suit the technology – the technology needs to be adapted to suit our lifestyle and for that, healthcare professionals do need to consider the psychological aspects of diabetes care more.

A leaflet and overview was also produced showing these top tips for cgm use. It is freely available to download at https://www.barnardhealth.com. These points should be discussed between healthcare professionals and patients, as well as with family members and carers.

The benefits of diabetes technologies and especially cgms is not limited to people living with type 1 diabetes. People with type 2 diabetes also see a huge improvement in their quality of life after using cgms.

The study mentioned here shows that even without actual intervention or change to their diabetes management – the fact that people with T2D had access to and were able to wear the device improved their quality of life and psychosocial functions during the 12 week review period. Astonishingly this seemed to be independent from actual glucose control, as no improvement of Time in Range was measured during this time period.

It is to be hoped that with more studies showing improvement of quality of life for all types of diabetes, the more urgent question of access for all people living with diabetes will be addressed further, until everyone can access and afford the technology needed to live with diabetes, not only with the burden of diabetes.

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