Continuous Glucose Monitoring Attrition in Youth With Type 1 Diabetes

Area of Science:

• Endocrinology
• Pediatrics
• Medical Device Technology

Background:

• Type 1 diabetes (T1DM) management in youth relies on continuous glucose monitoring (CGM) for improved glycemic control.
• CGM attrition, or discontinuation, poses a significant challenge to achieving optimal health outcomes in this population.

Purpose of the Study:

• To determine the primary reasons for and the typical timing of CGM attrition among adolescents and young adults with T1DM.
• To identify demographic and clinical factors associated with CGM discontinuation.

Main Methods:

• A retrospective chart review was conducted on 2663 youth (<22 years) with T1DM treated at a single center.
• Data were extracted from CGM cloud-based software and electronic medical records between November 2021 and October 2022.

Main Results:

• CGM attrition occurred in 5.9% (n=311) of youth, with a median discontinuation time of 4 months and 21 days post-initiation.
• Discontinuation was more prevalent in older youth, those with longer T1DM duration, higher A1C, and among non-Hispanic Black (NHB) and Latine individuals.
• Key reasons for attrition included device adhesion problems (18.4%), discomfort (10.8%), insurance issues (9.5%), pain (8.3%), and mistrust in device accuracy (8.2%).

Conclusions:

• Early interventions within the first six months of CGM initiation are crucial for sustained use.
• Education should focus on practical solutions for adhesion and wearability, alongside clear guidance on supply procurement.
• Addressing insurance barriers is vital, particularly for NHB and Latine youth, to promote equitable CGM access and adherence.