Motivational Stage at CGM Initiation Is Less Important than Timing of CGM Initiation in Predicting CGM Adherence

Background: Readiness for making behavioral changes is a key factor determining success in the adoption of technologies like CGM in type 1 diabetes (T1D). SOCRATES (Stages of Change Readiness and Treatment Eagerness Scale-Diabetes Version) can classify individuals into 1 of 5 motivational stages: Precontemplation, Contemplation, Determination, Action and Maintenance. It was used in the CGM TIME Trial, a multicenter pediatric RCT comparing simultaneous pump and CGM (“SIM” group) to initiation of CGM 6 months later (“DEL” group) (MiniMed Veo^™ System).

Aim: To examine the association of SOCRATES scores with 1) A1C at trial entry and 2) CGM adherence and change in A1C 6 months after CGM initiation.

Methods: 97/99 eligible children aged 10-18 years and 136/141 eligible parents completed SOCRATES at trial entry and 6 months. Multivariable linear regression tested the association between motivational stage and 1) child’s A1C at trial entry, and 2) change in A1C and CGM adherence 6 months after CGM initiation, adjusted for randomization group, gender, age, and diabetes duration.

Results: At trial entry, mean adjusted A1C was 1.02% lower for children in Precontemplation than those in Action (p<0.0001). The A1C of children whose parents were in Precontemplation was 0.83% lower than those in Maintenance (p=0.02) and 0.35% lower than those in Action (p=0.048). Motivational stage of children and parents at CGM initiation was not associated with CGM adherence or change in A1C 6 months later whereas there was an intervention effect with the SIM group using CGM an additional 3.4 hours per day (p=0.03) compared to the DEL group.

Conclusions: SOCRATES scores were associated with A1C at trial entry, but did not predict future CGM adherence or change in A1C. SOCRATES was a poor measure of readiness for change in children with T1D and their parents who were participating in a clinical trial. CGM adherence was related more to timing of CGM initiation than motivational stage.