Treatment Satisfaction and Well-Being With Continuous Glucose Monitoring in People With Type 1 Diabetes: An Analysis Based on the GOLD Randomized Trial

J Diabetes Sci Technol. 2025 Jan;19(1):143-152. doi: 10.1177/19322968231183974. Epub 2023 Jul 27.

Abstract

Background: The GOLD trial demonstrated that continuous glucose monitoring (CGM) in people with type 1 diabetes (T1D) managed with multiple daily insulin injections (MDI) improved not only glucose control but also overall well-being and treatment satisfaction. This analysis investigated which factors contributed to improved well-being and treatment satisfaction with CGM.

Methods: The GOLD trial was a randomized crossover trial comparing CGM versus self-monitored blood glucose (SMBG) over 16 months. Endpoints included well-being measured by the World Health Organization-Five Well-Being Index (WHO-5) and treatment satisfaction by the Diabetes Treatment Satisfaction Questionnaire (DTSQ) as well as glucose metrics. Multivariable R2-decomposition was used to understand which variables contributed most to treatment satisfaction.

Results: A total of 139 participants were included. Multivariable analyses revealed that increased convenience and flexibility contributed to 60% (95% confidence interval [CI] = 50%-69%) of the improvement in treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire change version [DTSQc]) observed with CGM, whereas perceived effects on hypoglycemia and hyperglycemia only contributed to 6% (95% CI = 2%-11%) of improvements. Significant improvements in well-being (WHO-5) by CGM were observed for the following: feeling cheerful (P = .025), calm and relaxed (P = .024), being active (P = .046), and waking up fresh and rested (P = .044). HbA1c reductions and increased time in range (TIR) were associated with increased treatment satisfaction, whereas glycemic variability was not. HbA1c reduction showed also an association with increased well-being and increased TIR with less diabetes-related distress.

Conclusions: While CGM improves glucose control in people with T1D on MDI, increased convenience and flexibility through CGM is of even greater importance for treatment satisfaction and patient well-being. These CGM-mediated effects should be taken into account when considering CGM initiation.

Keywords: CGMS; MDI; SMBG; quality of life; treatment satisfaction; type 1 diabetes.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Blood Glucose Self-Monitoring*
  • Blood Glucose* / analysis
  • Blood Glucose* / drug effects
  • Continuous Glucose Monitoring
  • Cross-Over Studies*
  • Diabetes Mellitus, Type 1* / blood
  • Diabetes Mellitus, Type 1* / drug therapy
  • Diabetes Mellitus, Type 1* / psychology
  • Female
  • Glycemic Control
  • Humans
  • Hypoglycemic Agents* / administration & dosage
  • Hypoglycemic Agents* / therapeutic use
  • Insulin* / administration & dosage
  • Insulin* / therapeutic use
  • Male
  • Middle Aged
  • Patient Satisfaction*
  • Surveys and Questionnaires

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin