The ACBRD collaborated with UK colleagues on this review of technology trials and cohort studies
By Ralph Geerling [1]
For people with diabetes, there is a large volume of evidence showing the importance of maintaining blood glucose within recommended targets. It reduces the risk of other long-term health problems. However, achieving these targets is often not without a cost to the person’s emotional well-being or quality of life. Worries about low or high glucose, and the efforts involved in planning for or avoiding these, can take a heavy toll. As the focus on glucose-related targets has increased, there has been advances in the technologies available to support these efforts.
The aim of this study was to review research that has asked how glucose technologies affect the quality of life of people living with type 1 diabetes. The studies included a range of technologies, including insulin pumps, continuous glucose monitoring devices, hybrid closed loop systems. The studies included randomised controlled trials. These are studies in which one technology is compared to another, and the people taking part are allocated at random to one group or the other. The studies also included cohort studies. These are studies that follow people up over a period of time, often much longer than is possible in a trial. There is no control group but we can learn more about how people experience the technologies in their everyday lives.
The focus of the review was on studies using person-reported outcome measures (PROMs). PROMs are questionnaires that have been shown to be valid and reliable measures of various experiences and outcomes that are best reported by the person. For example, diabetes distress, emotional well-being satisfaction with treatments, sleep quality, fear of hypoglycaemia, and the impact of diabetes on quality of life. PROMs are valuable for monitoring symptoms, informing treatment plans, demonstrating issues that matter to people with diabetes and strengthening communication between them and their health professionals.
So, what were the findings?
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- PROMs were rarely the main focus of the studies, but this does not make them any less important.
- Generally, most of the PROMs showed that the technologies offered benefits to the people using them. This was particularly true for the diabetes-specific PROMs.
- Fear of hypos (low glucose) is very common among people living with type 1 diabetes. Importantly, the review showed that that technologies reduced fear of hypos, and the negative impact that this fear can have on people’s quality of life.
- There were mixed findings on the impact of technologies on diabetes distress. This may be because diabetes distress is not solely focused on the distress related to managing glucose.
- There were no benefits of the technologies in terms of effects on generic PROMs, e.g. assessing general anxiety and depression. This may be for several reasons. For example, it may be because people with anxiety and depression do not take part in such studies, or because technologies have limited benefits for underlying mental health problems.
- Most of the research focused on assessing the extent to which technologies reduced known negative impacts (e.g. fear of hypos, diabetes distress). There was very little research focused on the impacts of technologies on positively-framed constructs, e.g. sleep quality, diabetes-specific positive well-being.
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The diabetes-specific PROMs, especially those assessing fear of hypos, show greater benefits of diabetes technologies, than generic PROMS. By understanding and valuing the impact of diabetes technology on PROMs, greater gains can be made in the clinical care and management of type 1 diabetes, with broader benefits for both health and quality of life of those living with the condition.
Reference:
Speight J, Choudhary P, Wilmot EG, Hendrieckx C, Forde H, Cheung WY, Crabtree T, Millar B, Traviss-Turner G, Hill A, Ajjan RA. 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. PMID: 36004676; PMCID: PMC10283013 [2].