Currently submitted to: Journal of Medical Internet Research
Date Submitted: Nov 12, 2025
Open Peer Review Period: Nov 12, 2025 - Jan 7, 2026
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The Devil Is In The Details: A Scoping Review of Real-time Psychological Factors Using Ecological Momentary Assessment (EMA) with Continuous Glucose Monitoring (CGM)
ABSTRACT
Background:
Ecological momentary assessment (EMA) is a tool that captures emotional states, experiences, and behaviors in real or near-real time. Using continuous glucose monitoring (CGM) data and EMA in unison may be beneficial to understand associations between psychosocial factors and momentary glucose levels. An in-depth understanding of these relationships is crucial for future interventions targeting psychosocial factors in chronic diseases such as diabetes mellitus.
Objective:
The goal of this scoping review was to summarize the objectives, methodologies, and outcomes of studies analyzing concurrent psychosocial EMA and CGM data.
Methods:
This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. One-hundred and six studies were identified from PubMed, Embase, and EBSCOhost from May 2009-Jan 2025. Thirteen original research articles that collected and analyzed simultaneous EMA and CGM data were included. Methodological data abstracted included study characteristics, EMA protocols and outcomes, CGM outcomes, and integrated EMA and CGM study objectives.
Results:
Studies primarily recruited adult (92%) populations with type 1 diabetes (T1DM) (69%). EMA delivery protocols and outcomes varied significantly and included emotion, self-care behaviors, disordered eating behaviors, interpersonal interactions, cognition, sleep, workload, and impacts of hypoglycemia. Most (69%) studies analyzed blinded CGM data and CGM outcomes included both standardized and non-standardized glucose outcomes. Integrated EMA and CGM data answered study objectives including evaluating impacts of psychosocial and lifestyle factors on momentary glucose metrics; the influence of momentary glucose on emotional states, mood, personal behaviors, sleep, and cognition; and study protocol or mobile application optimization among others.
Conclusions:
The combination of EMA and CGM data provides an opportunity to elucidate the relationship between psychological and behavioral factors with momentary glucose. In this review, we describe a broad range of study characteristics, protocols, outcome measures, and objectives using these novel combined methodologies. Clinical Trial: Not applicable
Citation
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