How CGM Boosts Self-Efficacy, Engagement with Self-Management, and Clinical Outcomes in Adults with Type 2 Diabetes: A Mixed Methods Study
Year: 2026
Type: other
Abstract: 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 semi-structured 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 = .004) and greater gains in engagement (+0.5 vs +0.1, p = .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. ARTICLE HIGHLIGHTS · Why did we undertake this study? To characterize how CGM use influences attitudes and self-management practices among adults with type 2 diabetes. · What is the specific question(s) we wanted to answer? We assessed which attitudinal and behavioral shifts occur with CGM initiation and whether these shifts relate to 3-month changes in engagement and HbA1c. · What did we find? Six themes emerged from qualitative interviews with 31 participants. Enhanced Self-Efficacy was the sole attitudinal theme associated with both greater HbA1c improvement and increased engagement. · What are the implications of our findings? Gains in self-efficacy appears to be a key pathway through which CGM improves outcomes, underscoring the need for onboarding, education and coverage approaches that build self-efficacy and sustain CGM use.
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W7125252995