Continuous Glucose Monitoring Reduces Severe Diabetes Distress Independently of Glycemic Improvement in Adults With Type 1 Diabetes: A Prospective Study in a Public Healthcare Setting.

Objectives

While technology improves glycemic control, its psychological impact in resource-limited settings is less explored. This study evaluated the impact of continuous glucose monitoring (CGM) on diabetes distress and glycemic outcomes in adults with type 1 diabetes (T1D) within a public healthcare system.

Methods

This prospective study enrolled 35 adults with T1D at a public center in Northeastern Brazil. Participants initiated CGM with monthly follow-ups. Diabetes distress was assessed at baseline and six months using Brazilian Type 1 Diabetes Distress Scale (T1DDS).

Results

Participants had a mean T1D duration of 13 ± 9.9 years and baseline HbA1c of 9.13 ± 1.87%. After six months, mean HbA1c decreased to 7.94 ± 1.28% (mean difference = -1.19%; p = 0.007). Time in range reached 54.4% within the first month and remained consistent throughout the follow-up. Total diabetes distress score decreased significantly from 2.86 ± 0.88 at baseline to 2.32 ± 0.85 at six months (mean difference = -0.28; p < 0.001; Cohen's dz = 0.76). The proportion of participants with severe distress dropped from 34.3% (n=12) to 14.3% (n=5) (p = 0.002). Major improvements in management and family/social domains. Psychosocial benefits were observed regardless of the magnitude of HbA1c reduction (r = -0.182, p = 0.384).

Conclusions

CGM implementation reduced diabetes distress, particularly severe cases, and improved glycemic parameters in a resource-limited setting. The improvement in well-being independent of glycemic drop suggests that CGM is a valuable tool for both clinical and psychosocial management of adults with T1D in public health systems.