CGM Usage Improves Glycemic, Psychosocial Outcomes for Type 1 Diabetes | ADA 2025

Patients with type 1 diabetes (T1D) can benefit from continuous glucose monitors (CGM), which improve glycemic and psychosocial outcomes, according to the ONBOARD randomized trial (NCT04161131). Currently, automated insulin delivery systems, such as an insulin pump with a CGM, are the standard of care for adults with T1D.¹

Investigators assessed continuous glucose monitoring with behavioral intervention for patients with type 1 diabetes. | Image Credit: Pixel-Shot - stock.adobe.com

Investigators of the study aimed to compare 3 months of CGM usage to CGM usage with behavioral interventions (ONBOARD) on glycemic and behavioral outcomes for patients with T1D who were not using CGMs prior. Patients tracked the metrics of A1c, time in glucose range, number of days using CGM, blood glucose downloads, diabetes problem solving, diabetes distress, and technology attitudes.

Investigators included patients aged 18 to 50 years who either did not use CGMs regularly in the past 6 months or were within the first year of CGM use. The primary outcome included A1c at 3 months, and secondary outcomes included the number of individuals who withdrew or were lost to follow-up, percentage of time in range, diabetes distress scale, glucose monitoring satisfaction, percentage of CGM data downloaded, mean glucose level, and barriers to diabetes devices.^1,2

The mean age was 34.7 years of the total 134 patients, with the mean age being 34.5 years for 67 included in the intervention group and 34.9 years for 67 in the CGM-only group. The individuals were 76.9%, 80.6%, and 73.1% female, respectively. As for race and ethnicity, 77.6% in the intervention group were white compared with 80.6% in the CGM-only group, 6% and 7.5% were Asian, 4.5% and 6% were more than 1 race, and 1.5% and 4.5% were Black, respectively. In both groups, the approximate length of diabetes was 19 years, A_1c was 8.2% and 7.9%, respectively, diabetes distress was both 2.5, approximately 40.3% and 50.8% used an insulin pump, respectively, and 73.1% and 76% used a CGM before, respectively.¹

Patients included in the CGM and OBOARD intervention group participated in 4 sessions between the 3-, 6-, and 12-month assessments. Patients in the CGM-only group received the standard care and only underwent the 3-, 6-, and 12-month assessments.¹

Investigators found that at 12 months, the intervention group had a change in A1c of -0.3 and -0.44 for the CGM-only group. It is important to note that the intervention group did have a decrease in A1c, but it slowly increased at 6 and 12 months. Further, diabetes distress decreased by 0.38. Approximately 41% of patients in the CGM group and 50% in the intervention group had insulin pump uptake of 3 months compared with 46% and 48%, respectively, at 12 months. For CGM uptake, the proportion of patients was 74% and 72%, respectively, at 3 months and 76% and 71%, respectively, at 12 months.¹

Investigators concluded that introducing CGMs can have benefits in both glycemic and psychological outcomes for patients with T1D, and most patients were still using CGMs at 12 months. However, they stated that further analyses are needed to determine the impact of the ONBOARD interventions beyond just CGM usage alone to treat T1D.¹

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REFERENCES

1. Tanenbaum ML, Liu Y, Pasmooij MB, Mulvaney SA, Hessler DM, Darji H, Hood KK. ONBOARD: A Randomized Controlled Trial Comparing CGM Alone or CGM Plus Behavioral Support for Adults with T1D. American Diabetes Association 85th Scientific Sessions. June 20 to 23, 2025. Chicago, Illinois.

2. Overcoming Barriers and Obstacles to Adopting Diabetes Devices (ONBOARD). ClinicalTrials.gov identification: NCT04161131. Updated September 12, 2022. Accessed June 23, 2025. https://clinicaltrials.gov/study/NCT04161131