Continuous Glucose Monitoring Attrition in Youth With Type 1 Diabetes

Abstract

Purpose

The purpose of the study was to identify the most common reasons for and timing of continuous glucose monitoring (CGM) attrition in youth with type 1 diabetes (T1DM).

Methods

This single center retrospective chart review included youth with T1DM <22 years seen between November 1, 2021, and October 31, 2022. Data were gathered from CGM cloud-based software and the electronic medical record.

Results

Among 2663 youth, 88.3% (n = 2351) actively used CGM, and 5.9% (n = 311) had CGM attrition. Those who discontinued CGM were older (17.0 vs 14.9 years, P = .0001), had a longer T1DM duration (7.4 vs 5.1 years), higher A1C (9% vs 7.4%), and were non-Hispanic Black (NHB; 34.0% vs 11.5%). The odds of CGM attrition were 5.0 and 2.8 times higher in NHB and Latine youth, respectively, compared to non-Hispanic White youth. Median time to CGM discontinuation was 4 months, 21 days after initiation; 57% of youth who discontinued did so in the first 6 months of use. The most common reasons for CGM attrition were problems with device adhesion (18.4%), dislike device on the body (10.8%), insurance problems (9.5%), pain with device use (8.3%), and system mistrust due to inaccurate readings (8.2%). NHB and Latine youth were more likely to discontinue CGM due to insurance problems (3.2% vs 15.1% vs 16.7%).

Conclusions

To support equitable, uninterrupted CGM use, education at CGM initiation should address practical approaches to improve adhesion and wearability and provide a clear pathway to obtaining supplies. Interventions to support sustained CGM use should occur within the first 6 months of initiation.