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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

Polonsky, William H., Hessler, Danielle, Ruedy, Katrina J., Beck, Roy W.·2017·Diabetes Care

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Abstract

OBJECTIVE Continuous glucose monitoring (CGM) improves glycemic control, but data are inconclusive about its influence on quality of life (QOL). We investigated the impact of 24 weeks of CGM use on QOL in adults with type 1 diabetes (T1D) who use multiple daily insulin injections. RESEARCH DESIGN AND METHODS DIAMOND (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes) was a prospective randomized trial that assessed CGM versus self-monitoring of blood glucose (SMBG) only in 158 adults with poorly controlled T1D. At baseline and study end, participants completed QOL measures that assessed overall well-being (WHO-5), health status (EQ-5D-5L), diabetes distress (DDS), hypoglycemic fear (worry subscale of the HFS-II), and hypoglycemic confidence (HCS). At study end, CGM participants completed the CGM Satisfaction Survey. Linear regression analyses compared treatment group changes in QOL outcomes over time. Associations between CGM satisfaction and change in QOL outcomes and in glycemic control indices were assessed. RESULTS The CGM group demonstrated a greater increase in hypoglycemic confidence (P = 0.01) and a greater decrease in diabetes distress (P = 0.01) than the SMBG group. No significant group differences in well-being, health status, or hypoglycemic fear were observed. CGM satisfaction was not significantly associated with glycemic changes but was associated with reductions in diabetes distress (P < 0.001) and hypoglycemic fear (P = 0.02) and increases in hypoglycemic confidence (P < 0.001) and well-being (P = 0.01). CONCLUSIONS CGM contributes to significant improvement in diabetes-specific QOL (i.e., diabetes distress, hypoglycemic confidence) in adults with T1D, but not with QOL measures not specific to diabetes (i.e., well-being, health status). CGM satisfaction was associated with most of the QOL outcomes but not with glycemic outcomes.

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Diabetes Technology Use in Adults with Type 1 and Type 2 Diabetes
Kravarusic, J., & Aleppo, G. (2019) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2019.10.006 · Cited by 46
Long-term Cost-Effectiveness of Dexcom G6 Real-time Continuous Glucose Monitoring Versus Self-Monitoring of Blood Glucose in Patients With Type 1 Diabetes in the U.K.
Roze, S., Isitt, J. J., Smith‐Palmer, J., Javanbakht, M., & Lynch, P. M. (2020) · Diabetes Care · doi:10.2337/dc19-2213 · Cited by 46
A Deep Learning Approach for Vital Signs Compression and Energy Efficient Delivery in mhealth Systems
Said, A. B., Al-Sa’d, M. F., Tlili, M., Abdellatif, A. A., Mohamed, A. M. S., Elfouly, T., Harras, K. A., & O’Connor, M. D. (2018) · IEEE Access · doi:10.1109/access.2018.2844308 · Cited by 42
“Chronic diseases, such as Epilepsy [4], Diabetes [5], Asthma [6], Alzheimer [7], etc.”
Background
Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field
Forlenza, G. P., Messer, L. H., Berget, C., Wadwa, R. P., & Driscoll, K. A. (2018) · Current Diabetes Reports · doi:10.1007/s11892-018-1078-1 · Cited by 43
A retrospective in‐depth analysis of continuous glucose monitoring datasets for patients with hepatic glycogen storage disease: Recommended outcome parameters for glucose management
Peeks, F., Hoogeveen, I. J., Feldbrugge, R. L., Burghard, R., de Boer, F., Fokkert‐Wilts, M. J., van der Klauw, M. M., Oosterveer, M. H., & Derks, T. G. J. (2021) · Journal of Inherited Metabolic Disease · doi:10.1002/jimd.12383 · Cited by 42
“For DM patients experiencing a high risk of hypoglycemia, real-time CGM can help to prevent hypoglycemia and contribute to improved quality of life.(19) In addition, CGM has proven to be a valuable monitoring modality in dietary and medical intervention trials with DM patients.”
Background
Time With Diabetes Distress and Glycemia-Specific Distress: New Patient-Reported Outcome Measures for the Psychosocial Burden of Diabetes Using Ecological Momentary Assessment in an Observational Study
Ehrmann, D., SCHMITT, A. J., Priesterroth, L., Kulzer, B., Haak, T., & Hermanns, N. (2022) · Diabetes Care · doi:10.2337/dc21-2339 · Cited by 40
Novel Detection and Progression Markers for Diabetes Based on Continuous Glucose Monitoring Data Dynamics
Montaser, E., Farhy, L. S., & Kovatchev, B. P. (2024) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgae379 · Cited by 45
Long-Term Glucose Forecasting Using a Physiological Model and Deconvolution of the Continuous Glucose Monitoring Signal
Liu, C., Vehí, J., Avari, P., Reddy, M., Oliver, N., Georgiou, P., & Herrero, P. (2019) · Italian National Conference on Sensors · doi:10.3390/s19194338 · Cited by 41
“Clinical data suggest that CGM can improve overall glucose control, as measured by glycated haemoglobin (HbA1c) [2], and can reduce the burden of extreme glucose values (hypo- and hyperglycaemia) [3].”
Background
Sustained Impact of Real-time Continuous Glucose Monitoring in Adults With Type 1 Diabetes on Insulin Pump Therapy: Results After the 24-Month RESCUE Study
Charleer, S., Block, C. E. M. D., Nobels, F. R. E., Radermecker, R. P., Lowyck, I., Mullens, A., Scarnière, D., Spincemaille, K., Strivay, M., Weber, E., et al. (2020) · Diabetes Care · doi:10.2337/dc20-1531 · Cited by 39
Glucose measurement in body fluids: A ready reckoner for clinicians
Kubihal, S., Goyal, A., Gupta, Y., & Khadgawat, R. (2020) · Diabetes & Metabolic Syndrome Clinical Research & Reviews · doi:10.1016/j.dsx.2020.11.021 · Cited by 40
Use of Continuous Glucose Monitors to Manage Type 1 Diabetes Mellitus: Progress, Challenges, and Recommendations
Friedman, J. G., Cardona, Z., Szmuilowicz, E. D., & Aleppo, G. (2023) · Pharmacogenomics and Personalized Medicine · doi:10.2147/pgpm.s374663 · Cited by 43
“CGM has proven to be effective in achieving glycemic goals while minimizing risk of hypoglycemia and contributing to improvement in quality of life.(4,5) Although implementation of CGM is not without its own challenges, CGM has been recognized as the standard of care for patients with T1D by various professional socie…”
Background
Cost-Effectiveness of a Real-Time Continuous Glucose Monitoring System Versus Self-Monitoring of Blood Glucose in People with Type 2 Diabetes on Insulin Therapy in the UK
Isitt, J. J., Roze, S., Sharland, H., Cogswell, G., Alshannaq, H. A., Norman, G. J., & Lynch, P. M. (2022) · Diabetes Therapy · doi:10.1007/s13300-022-01324-x · Cited by 40
“The FoH utility was based on the Hypoglycemia Fear Survey (HFS) from the DIAMOND trial [46], which was mapped to the EQ-5D by utilizing a study from Currie et al.”
Method
Enhancing Type 1 Diabetes Immunological Risk Prediction with Continuous Glucose Monitoring and Genetic Profiling
Montaser, E., Farhy, L. S., & Rich, S. S. (2024) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2024.0496 · Cited by 39
“5,6 CGM-derived metrics 7 provide valuable insights into glucose dynamics, offering a more comprehensive assessment of glycemic control than traditional methods.”
Fear of hypoglycaemia in patients with type 1 and 2 diabetes: a systematic review
Zhang, Y., Li, S., Zou, Y., Wu, X., Bi, Y., Zhang, L., Yuanyuan, Gong, W., & Hayter, M. (2020) · Journal of Clinical Nursing · doi:10.1111/jocn.15538 · Cited by 36
Continuous Glucose Monitor, Insulin Pump, and Automated Insulin Delivery Therapies for Type 1 Diabetes: An Update on Potential for Cardiovascular Benefits
PAULEY, M. E., Tommerdahl, K. L., Snell‐Bergeon, J. K., & Forlenza, G. P. (2022) · Current Cardiology Reports · doi:10.1007/s11886-022-01799-x · Cited by 39
Continuous glucose monitors and virtual care in high-risk, racial and ethnic minority populations: Toward promoting health equity
Vrany, E. A., Hill‐Briggs, F., Ephraim, P. L., Myers, A. K., Garnica, P., & Fitzpatrick, S. L. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1083145 · Cited by 36
“It is well-established that CGM use improves the health and well-being of many patients with diabetes (11, 15, 16).”
Background
The impact of hypoglycaemia on daily functioning among adults with diabetes: a prospective observational study using the Hypo-METRICS app
Søholm, U., Broadley, M. M., Zaremba, N., Divilly, P., Baumann, P. M., MAHMOUDI, Z., Martine‐Edith, G., Mader, J. K., Cigler, M., Brøsen, J. M. B., et al. (2024) · Diabetologia · doi:10.1007/s00125-024-06233-1 · Cited by 33
“While CGM offers considerable advantages in terms of minimising hypo-glycaemia, optimising overall glucose levels and improving diabetes-specific QoL [34, 35], the current study highlights some potential disadvantages.”
Empowering hospitalized patients with diabetes: implementation of a hospital-wide CGM policy with EHR-integrated validation for dosing insulin
Lee, M. Y., Seav, S. M., Ongwela, L., Lee, J. J., Aubyrn, R., Cao, F. Y., Kalinsky, A., Aparicio Ramos, O., Gu, Y., Kingston, K., et al. (2024) · Diabetes Care · doi:10.2337/dc24-0626 · Cited by 32
Acceptability of Continuous Glucose Monitoring in Elderly Diabetes Patients Using Multiple Daily Insulin Injections
Volčanšek, Š., Lunder, M., & Janež, A. (2019) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2019.0131 · Cited by 32
The assessment and management of quality of life of older adults with diabetes mellitus
Kassem, L. S., & Aron, D. C. (2020) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2020.1737520 · Cited by 35
Blood Glucose Monitoring in Adults and Children with Diabetes: Update 2021
CHENG, A. Y. Y., Feig, D. S., Ho, J., Siemens, R. L., BAJAJ, H. S., Gilbert, J. D., Houlden, R. L., Kim, J., MacKay, D., Rabi, D. M., et al. (2021) · Canadian Journal of Diabetes · doi:10.1016/j.jcjd.2021.07.003 · Cited by 36
Accuracy of a Fourth-Generation Continuous Glucose Monitoring System in Children and Adolescents with Type 1 Diabetes
Slover, R. H., Tryggestad, J. B., DiMeglio, L. A., Fox, L. A., Bode, B. W., Bailey, T. S., Brazg, R., Christiansen, M. P., Sherr, J. L., Tsalikian, E., et al. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0109 · Cited by 31
Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review
Jacobsen, L. M., Sherr, J. L., Considine, E. G., Chen, A., Peeling, S., Hulsmans, M., Charleer, S., Urazbayeva, M., Tosur, M., ALAMARIE, S. A., et al. (2023) · Communications Medicine · doi:10.1038/s43856-023-00358-x · Cited by 34
Patterns and Trends in Continuous Glucose Monitoring Utilization Among Commercially Insured Individuals With Type 1 Diabetes: 2010–2013 to 2016–2019
LACY, M. E., Lee, K. E., Ataç, Ö., Heier, K., Fowlkes, J. L., Kucharska‐Newton, A., & Moga, D. C. (2024) · Clinical Diabetes · doi:10.2337/cd23-0051 · Cited by 32
Personal Versus Professional Continuous Glucose Monitoring: When to Use Which on Whom
Longo, R. R., & Sperling, S. B. (2019) · Diabetes Spectrum · doi:10.2337/ds18-0093 · Cited by 30
“Considerations CGM use has been shown to improve diabetes-specific quality of life measures, including reducing diabetes distress and increasing hypoglycemia confidence compared to SMBG (29).”
Background
Benefits and limitations of continuous glucose monitoring in type 1 diabetes
Stone, J. Y., & Bailey, T. S. (2020) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2020.1706482 · Cited by 30
“distress as compared to use of SMBG only [38].”
Method
Transdermal amperometric biosensors for continuous glucose monitoring in diabetes
Liu, Y., Li, Y., & Cui, Y. (2022) · Talanta · doi:10.1016/j.talanta.2022.124033 · Cited by 29
Current Technologies for Managing Type 1 Diabetes Mellitus and Their Impact on Quality of Life—A Narrative Review
Elian, V., Popovici, V., Ozon, E.-A., Musuc, A. M., Fița, A. C., Rusu, E., Radulian, G., & Lupuliasa, D. (2023) · Life · doi:10.3390/life13081663 · Cited by 34
“The satisfaction was directly correlated with diminishing diabetes distress and hypoglycemic fear and increasing wellbeing and hypoglycemic confidence [127].”
Background
Diabetes Technology Trends: A Review of the Latest Innovations
Lundgrin, E. L., Kelly, C. A., Bellini, N. J., Lewis, C. J., Rafi, E., & Hatipoğlu, B. (2025) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaf034 · Cited by 32
Psychosocial Aspects of Diabetes Technology
Polonsky, W. H. (2019) · Endocrinology and Metabolism Clinics of North America · doi:10.1016/j.ecl.2019.10.003 · Cited by 29
Practical aspects of diabetes technology use: Continuous glucose monitors, insulin pumps, and automated insulin delivery systems
Marks, B. E., Williams, K. M., Sherwood, J. S., & Putman, M. S. (2021) · Journal of Clinical & Translational Endocrinology · doi:10.1016/j.jcte.2021.100282 · Cited by 30
“[19] Polonsky WH, Hessler D, Ruedy KJ, Beck RW.”
Background
The road from intermittently scanned continuous glucose monitoring to hybrid closed-loop systems. Part B: results from randomized controlled trials
Ridder, F. D., den Brinker, M., & Block, C. E. M. D. (2019) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018819871903 · Cited by 29
Type 1 diabetes-related distress: Current implications in care
Rodríguez-Muñoz, A., César, M. J. P., Tinahones, F. J., & Martínez‐Montoro, J. I. (2024) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2024.03.030 · Cited by 31
Implantable and transcutaneous continuous glucose monitoring system: a randomized cross over trial comparing accuracy, efficacy and acceptance
Boscari, F., Vettoretti, M., Cavallin, F., Amato, A. M. L., Uliana, A., Vallone, V., Avogaro, A., Facchinetti, A., & Bruttomesso, D. (2021) · Journal of Endocrinological Investigation · doi:10.1007/s40618-021-01624-2 · Cited by 28
“It includes 4 subscales [emotional burden, 5 items (EB), physician-related distress subscale, 4 items (PD), regimen related distress subscale, 5 items (RD), diabetes-related interpersonal distress subscale, 3 items (ID)] [24, 25].”
Background
Continuous glucose monitoring in patients with post‐bariatric hypoglycaemia reduces hypoglycaemia and glycaemic variability
Cummings, C., Jiang, A., Sheehan, A., Ferraz‐Bannitz, R., Puleio, A., Simonson, D. C., Dreyfuss, J. M., & Patti, M. E. (2023) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.15096 · Cited by 27
“sleeping and when driving, as well as improvements in disease-related and interpersonal distress.(53) In this same study, satisfaction with CGM use correlated with disease-specific quality of life.”
Background

Authors: Polonsky, W. H., Hessler, D., Ruedy, K. J., & Beck, R. W.
Affiliations: University of California San Diego (US)
University of California, San Francisco (US)
Jaeb Center for Health Research (US)
Corresponding author: Polonsky, William H.
ORCID: Polonsky, William H.
Hessler, Danielle
Beck, Roy W.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2017-04-07
Volume: 40
Issue: 6
Pages: 736-741
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc17-0133
OpenAlex: W2604156892
Cited by: 346
References: 22
Citations by year: 2026: 41 · 2025: 35 · 2024: 50 · 2023: 45 · 2022: 39 · 2021: 33 · 2020: 33 · 2019: 35 · 2018: 30 · 2017: 5
FWCI: 22.25
Type: journal article
Language: en
Open access: closed
Licence: www.diabetesjournals.org/content/license (vor, 45 d)
Locations: Diabetes Care (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: continuous glucose monitoring, type 1 diabetes, quality of life, diabetes distress, self-monitoring of blood glucose, multiple daily insulin injections, glycemic control, adults with diabetes
MeSH terms: Adult, Aged, Anxiety, Blood Glucose, Diabetes Mellitus, Type 1, Female, Follow-Up Studies, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Prospective Studies, Quality of Life, Blood Glucose Self-Monitoring, Biomarkers, Linear Models

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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

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