Does wearing a real-time continuous glucose monitor (RT-CGM) all the time matter? A cross-sectional study of use intensity and fear of hypoglycemia

Abstract

Introduction: Fear of hypoglycemia (FOH) hinders optimal glycemic control in type 1 diabetes (T1D). Real-time continuous glucose monitoring (RT-CGM) can alleviate FOH; however, the minimum sensor wear time required is unclear. Methods: In this single-center, cross-sectional study, we analyzed 43 adults with T1D who had used RT-CGM during the preceding 24 weeks. Participants were classified as continuous users (sensor active every week, n=26) or intermittent users (cumulative 4-12 weeks, n=17). FOH was measured with the validated Turkish hypoglycemia fear survey II. Group differences were examined with Student's t or chi 2tests (alpha=0.05). Pearson correlations and multiple linear regression were used to explore FOH predictors. Results: Mean HFS II scores (continuous vs. intermittent) were 17.7 +/- 13.1 vs. 14.5 +/- 6.7 for behavior, 19.0 +/- 13.7 vs. 20.4 +/- 14.4 for worry, and 36.7 +/- 22.1 vs. 34.9 +/- 18.6 for total (no statistically significant difference was observed between groups). Higher HFS total correlated with poorer self-reported treatment adherence (r:-0.32, p=0.04) and showed a non-significant inverse trend with longer diabetes duration (r:-0.27, p=0.08). Worry scores were higher in participants who reported recent symptomatic hyperglycemia (p=0.03). In the multivariable model, RT-CGM use intensity was not an independent predictor of FOH (beta =-1.2, 95% confidence interval:-9.5 to 7.1; p=0.77). Conclusion: Partial RT-CGM use (4-12 weeks over six months) produced FOH scores comparable to uninterrupted use, suggesting that continuous wear may not be necessary for short-term psychological benefit. FOH remained linked to treatment adherence, diabetes duration, and recent hyperglycemic events. Larger prospective studies with objective wear time data are warranted to define the threshold at which RT-CGM confers additional FOH reduction.