Systematic Review or Meta-analysis
Best friend or spy: a qualitative meta-synthesis on the
impact of continuous glucose monitoring on life with
Type 1 diabetes
L. H. Messer
, R. Johnson
, K. A. Driscoll
and J. Jones
University of Colorado, Barbara Davis Center, Aurora and
University of Colorado, College of Nursing,Denver, CO, USA
Accepted 12 December 2017
This is a meta-synthesis of extant qualitative literature related to impact of continuous glucose monitoring
(CGM). CGM has been available for a decade for the management of Type 1 diabetes and is the lynchpin of future
artiﬁcial pancreas technologies. Clinical uptake of CGM is an important area of inquiry. The purpose of this meta-
synthesis is to understand the impact of CGM on individuals with Type 1 diabetes and others (parents, signiﬁcant others,
providers) in order to design appropriate clinical interventions for adherence.
Studies published in English between 2007 and 2017 were included, reﬂecting commercial CGM availability.
PubMed, PsychINFO, CINALH, Web of Science and EMBASE databases were queried using search terms related to
CGM, qualitative, experience and Type 1 diabetes. Included articles contained original qualitative or mixed-method
research on CGM, sensor-augmented pump or closed-loop therapies. Articles underwent quality appraisal and thematic
interpretive integration by a multidisciplinary team.
Nine articles (343 participants) met the inclusion criteria and were included in the synthesis. Six novel themes
emerged: interacting with CGM, burden of living with CGM, feeling different from others, feeling empowered,
interacting with glucose information and impact on relationships.
CGM affects physical, emotional and relational aspects of life. Clinicians can help minimize the burden of
CGM with carefully delivered education and expectation-setting with individuals. Empowerment and relational partner-
ships in diabetes care can be explored to maximize satisfaction with CGM. Systematic interpretive synthesis of qualitative
studies provides a comprehensive, contextual understanding of the impact of CGM on daily life and relationships.
Diabet. Med. 35, 409–418 (2018)
Enormous advances in the treatment of Type 1 diabetes
mellitus have been made in the past decade, with new and
sophisticated technologies coming to the forefront of care.
Continuous glucose monitors (CGM) became commercially
available in the middle of the ﬁrst decade of the 21st century,
and have been shown to improve long-term glycaemic
outcomes as well as reduce incidence of hypoglycaemia
[1–3]. CGM systems comprise a subcutaneous glucose
sensor, a transmitter afﬁxed to the skin and attached to the
sensor, and a wireless receiver or mobile phone that displays
the glucose results every 5 min. They are often coupled with
an insulin pump to minimize the number of devices.
CGM utility is increasing dramatically with new applica-
tions. Until very recently, CGMs have been adjunctive
therapy to standard blood glucose monitoring . This
changed in 2016 when the USA approved the Dexcom G5
System for replacement of blood glucose testing . Further,
CGM is a lynchpin of automated insulin delivery systems,
including low and predicted low glucose suspend, hybrid
closed-loop and full artiﬁcial pancreas technologies [6,7].
Examples of these include the Medtronic Veo (low glucose
suspend) and 640G (predictive low suspend) in the UK,
Europe and Australia, and the Medtronic 530G (low glucose
suspend) and 670G (hybrid closed-loop) in the USA. With all
these new utilities of CGM coming to fruition, it is
imperative that clinicians consider the user experience with
CGM to identify intervention targets for sustainable use.
CGM technology has evolved over time to increase
usability and user satisfaction. Studies with early CGM
Correspondence to: Laurel H. Messer. E-mail: Laurel.Messer@ucdenver.edu
ª 2017 Diabetes UK