JMIR Publications

ABSTRACT

Background:

Food choices play a significant role in achieving glycemic goals and optimizing overall health for people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) can provide a comprehensive look at the impact of foods and other behaviors on glucose in real-time and over the course of time. The impact of using a nutrition-focused approach when initiating CGM and in people with T2D is unknown.

Objective:

To understand the perspectives and behaviors of people with T2D who participated in a nutrition-focused approach (NFA) during CGM initiation.

Methods:

Semi-structured qualitative interviews were conducted with UNITE study participants (Using Nutrition to Improve Time in rangE; NCT05988957). UNITE was a two-session intervention designed to introduce and initiate CGM using a NFA in people with T2D who do not use insulin. The intervention included CGM initiation materials that emphasized the continuous glucose monitor as a tool to guide evidence-based food choices. The materials were designed to support a conversation between the CGM user and the diabetes care provider conducting the sessions. A rapid matrix analysis approach was designed to answer two main questions 1) How do people who people who participate in a nutrition-focused approach during CGM initiation describe this experience? 2) What do people who participate in a nutrition-focused approach during CGM initiation do? How do they use CGM data to make food-related decisions and what food-related changes do they make?

Results:

Fifteen people completed interviews within two weeks of completing the UNITE study intervention. Participants identified as white (87%), male (60%) and, on average, were 64 years old, had T2D duration for 7.5 years, and an HbA1c of 7.5%. Participants fluently discussed glycemic metrics like time in range (% time with glucose 70-180 mg/dL) and reported using real-time and retrospective CGM data regularly. Participants liked the simplicity of the intervention materials (e.g., images, messaging), which demonstrated how to use CGM data to learn the glycemic impact of food choices and suggested how to adjust food choices for improved glycemia. Participants reported that CGM data impacted how they thought about food and most participants made changes as a result of seeing this data. Many of the reported changes aligned with evidence-based guidance for a healthy lifestyle, such as prioritizing non-starchy vegetables, reducing foods with added sugar, or walking more; however, some people reported behavior changes such as skipping or delaying meals in order to stay “in range.” A few participants reported that the CGM amplified negative feelings about food or eating.

Conclusions:

Participants agreed that pairing nutrition information with CGM initiation instructions was helpful for their diabetes care. In general, the nutrition-focused approach during CGM initiation was well-received and led to positive changes in food choices and behaviors during a two-month intervention. Clinical Trial: ClinicalTrials.gov ID NCT05988957