The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey.

This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones ( = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents ( = 549, 52.2%) and one third the respondents with type 2 DM ( = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21⁻2.39); smokers (1.63, 95% CI: 1.15⁻2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15⁻2.32). CGM use (AOR = 0.66, 95% CI: 0.44⁻1.00); "general diet" (AOR = 0.86, 95% CI: 0.79⁻0.94); and "blood glucose monitoring" (AOR = 0.88, 95%CI: 0.80⁻0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09⁻0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04⁻3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00⁻1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74⁻3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07⁻5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41⁻0.96) and "general diet" self-care (AOR = 0.84, 95% CI: 0.75⁻0.94), were significantly associated with the reduced odds of hyperglycemia. Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.