How CGM Boosts Self-Efficacy, Engagement With Self-Management, and Clinical Outcomes in Adults With Type 2 Diabetes: A Mixed-Methods Study

OBJECTIVE Continuous glucose monitoring (CGM) improves type 2 diabetes (T2D) outcomes, but how this is achieved remains unclear. We explored how CGM affects diabetes-related attitudes and behavior, and whether these changes are associated with engagement in self-management and glycemic outcomes. RESEARCH DESIGN AND METHODS T2D adults who completed the FreeStyle Libre 3 (FSL3) arm of a 3-month randomized controlled trial were invited to participate in semistructured interviews. Thematic analysis was used to identify attitudinal and behavioral themes. Linear regression tested whether themes were associated with changes in self-reported engagement and HbA1c. RESULTS Thirty-one of 47 (66%) FSL3 arm participants were interviewed. Three attitudinal themes emerged: greater awareness, effective decision-making, and enhanced self-efficacy. Behavioral themes included diet modifications, physical activity changes, and medication-taking changes. Participants reporting enhanced self-efficacy (65% of the sample) showed greater HbA1c reductions (1.5% [16 mmol/mol] vs. 0.1% [1 mmol/mol], P = 0.004) and greater gains in engagement (0.5 vs. 0.1, P = 0.005) than those who did not. CONCLUSIONS CGM use is associated with meaningful improvements in diabetes-related attitudes and behaviors. Enhanced diabetes self-efficacy, in particular, may be a key pathway by which CGM improves glycemic outcomes and engagement in self-management among adults with T2D.