Pylov Daniel, Polonsky William, Imberg Henrik, Holmer Helen, Hellman Jarl, Wijkman Magnus, Bolinder Jan, Heisse Tim, Dahlqvist Sofia, Nyström Thomas, Schwarz Erik, Hirsch Irl, Lind Marcus
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Diabetes Sci Technol. 2025 Jan;19(1):143-152. doi: 10.1177/19322968231183974. Epub 2023 Jul 27.
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.
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 R-decomposition was used to understand which variables contributed most to treatment satisfaction.
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 version [DTSQ]) 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 ( = .025), calm and relaxed ( = .024), being active ( = .046), and waking up fresh and rested ( = .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.
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.
GOLD试验表明，对于采用多次每日胰岛素注射（MDI）治疗的1型糖尿病（T1D）患者，持续葡萄糖监测（CGM）不仅改善了血糖控制，还提高了总体幸福感和治疗满意度。本分析调查了哪些因素促成了CGM带来的幸福感和治疗满意度的提高。
GOLD试验是一项随机交叉试验，比较了16个月内CGM与自我监测血糖（SMBG）的效果。终点指标包括通过世界卫生组织五福指数（WHO-5）衡量的幸福感、糖尿病治疗满意度问卷（DTSQ）评估的治疗满意度以及血糖指标。采用多变量R分解来了解哪些变量对治疗满意度的贡献最大。
共纳入139名参与者。多变量分析显示，CGM带来的便利性和灵活性提高对治疗满意度（糖尿病治疗满意度问卷版本[DTSQ]）改善的贡献率为60%（95%置信区间[CI]=50%-69%），而对低血糖和高血糖的感知影响仅占改善贡献率的6%（95%CI=2%-11%）。CGM使幸福感（WHO-5）在以下方面有显著改善：感到愉快（P=.025）、平静放松（P=.024）、积极活跃（P=.046）以及醒来时精神饱满且休息良好（P=.044）。糖化血红蛋白（HbA1c）降低和血糖达标时间（TIR）增加与治疗满意度提高相关，而血糖变异性则不然。HbA1c降低还与幸福感增加相关，TIR增加与糖尿病相关困扰减少相关。
虽然CGM改善了接受MDI治疗的T1D患者的血糖控制，但CGM带来的更高便利性和灵活性对治疗满意度和患者幸福感更为重要。在考虑启动CGM时，应考虑这些CGM介导的效应。
