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HbA1c levels were lower in CGM users compared to nonusers. While CGM use has improved substantially over time, more than half of respondents cited cost or insurance coverage as a significant barrier to use (42). Modifiable reasons for avoiding use include the hassle of devices (47%) and aversion to having a device attached to the body (35%). In a multi-national study of 263 patients, persistent sensor use for 12 months was only 30% (43). Improvement in A1C was associated with higher A1C at baseline, older age, and more frequent sensor use. Diabetes related hospital admissions were reduced following the initiation of sensor augmented pump therapy and fear of hypoglycemia improved. In the 6-month follow-up phase of the JDRF-CGM trial, RT-CGM was initiated in the control group in a manner that more closely approximates clinical practice (44). Investigators found a significant reduction in CGM use in all age groups over time. However, increasing sensor use was associated with A1C reduction. Moreover, in a study of over 29,000 pediatric patients with type 1 diabetes in the Type 1 diabetes Exchange Registry or the German/Austrian DPV Initiative, pediatric CGM use was associated with lower mean HbA1c regardless of insulin delivery modality (pump or injection (45). It is likely that adherence will improve as technologies improve.

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