Patient Perspectives on the Ambulatory Glucose Profile Report for Type 1 Diabetes Management in Adults: A National Online Survey.

OBJECTIVES: Continuous and flash glucose monitoring devices produce data reports (e.g. ambulatory glucose profile [AGP]) that can be used by people with diabetes and health-care providers (HCPs). Clinical benefits of these reports have been published, but the patient perspective is underreported. METHODS: We conducted an online survey for adults with type 1 diabetes (T1D) using continuous/flash glucose monitoring to understand their use and attitudes toward the AGP report. Barriers and facilitators related to digital health technology were explored. RESULTS: The survey included 291 respondents: 63% were <40 years of age, and 65% had been living with T1D for >15 years. Nearly 80% reviewed their AGP report, with 50% often discussing it with their HCP. Support from family and HCPs was positively associated with the use of the AGP report, and there was a positive relationship between motivation and better understanding of the AGP report (odds ratio=2.61; 95% confidence interval, 1.45 to 4.71). Nearly all respondents (92%) indicated that the AGP report is important for their diabetes management, but most indicated dissatisfaction with the cost of the device. Open-ended responses suggested some concern with the complexity of information from the AGP report. CONCLUSIONS: The online survey showed that there may be few barriers to the use of the AGP report by people with T1D, with the main barrier being its cost of the devices. Facilitators for the use of the AGP report included motivation and support from both family and the HCP. Facilitating discussion between HCPs and patients may be a strategy to improve the use and potential benefit of the AGP.

Resistance to data loss from the Freestyle Libre: impact on glucose variability indices and recommendations for data analysis.

Like many wearables, flash glucose monitoring relies on user compliance and is subject to missing data. As recent research is beginning to utilise glucose technologies as behaviour change tools, it is important to understand whether missing data are tolerable. Complete Freestyle Libre data files were amputed to remove 1-6 h of data both at random and over mealtimes (breakfast, lunch, and dinner). Absolute percent errors (MAPE) and intraclass correlation coefficients (ICC) were calculated to evaluate agreement and reliability. Thirty-two (91%) participants provided at least 1 complete day (24 h) of data (age: 44.8 ± 8.6 years, female: 18 (56%); mean fasting glucose: 5.0 ± 0.6 mmol/L). Mean and continuous overall net glycaemic action (CONGA) (60 min) were robust to data loss (MAPE ≤3%). Larger errors were calculated for standard deviation, coefficient of variation (CV) and mean amplitude of glycaemic excursions (MAGE) at increasing missingness (MAPE: 2%-10%, 2%-9%, and 4%-18%, respectively). ICC decreased as missing data increased, with most indicating excellent reliability (>0.9) apart from certain MAGE ICCs, which indicated good reliability (0.84-0.9). Researchers and clinicians should be aware of the potential for larger errors when reporting standard deviation, CV, and MAGE at higher rates of data loss in nondiabetic populations. But where mean and CONGA are of interest, data loss is less of a concern. Novelty: As research now utilises flash glucose monitoring as behavioural change tools in nondiabetic populations, it is important to consider the influence of missing data. Glycaemic variability indices of mean and CONGA are robust to data loss, but standard deviation, CV, and MAGE are influenced at higher rates of missingness.