<p><strong>OBJECTIVE: </strong>The ability of continuous glucose monitoring (CGM) to improve diabetes outcomes depends upon consistent use. To identify factors that facilitate long-term use of CGM, this study tested the hypothesis that youth involvement in the decision to initiate this therapy would influence subsequent CGM use and that CGM self-efficacy and satisfaction mediate this relationship.</p>

<p><strong>RESEARCH DESIGN AND METHODS: </strong>Before initiating CGM, parent-youth dyads (i.e., pairs) from an academic endocrinology clinic completed assessments, including a measure of the child's involvement in the decision to start CGM. Two months into CGM use, youth completed measures of CGM self-efficacy and satisfaction. Fidelity of CGM use between weeks 5 and 12 was accessed via a cloud-based data repository. Hypotheses were tested with linear mixed effects models, accounting for patients clustered within provider and repeated measures within patients.</p>

<p><strong>RESULTS: </strong>CGM use in 108 dyads (youth mean age 13.4 ± 2.7 years; 73% white) was positively predicted by baseline parent report of youth involvement in the CGM decision ( &lt; 0.0001), and this relationship was mediated by youth's perceptions of CGM self-efficacy ( &lt; 0.0001) and hassle ( = 0.014). So, when the youth shared their opinions about CGM with parents and participated in the decision to start, they perceived higher self-efficacy and lower hassle at 2-month follow-up, which predicted more days of use. This pattern held in models adjusting for youth race and sex and family income.</p>

<p><strong>CONCLUSIONS: </strong>To achieve maximum clinical benefit from CGM use, providers should facilitate youth involvement in the decision to initiate the device.</p>