Usability, acceptability and feasibility of continuous glucose monitoring among children and adolescents with type 1 diabetes in Kenya

Introduction

Continuous Glucose Monitoring (CGM) is considered standard care in high-income countries. There is, however, limited published evidence on CGM use in low– and middle-income countries. The purpose of this study was to assess the usability, acceptability, and feasibility of CGM use among people living with type 1 diabetes (T1D) and caregivers in a low-resource setting.

Research Design and Methods

This prospective study conducted at the Kenyatta National Hospital purposively enrolled persons aged 4-25 years who had been on management for T1D for at least six months, and caregivers of those under 18 years. Fourty youth living with T1D used CGM for three months in place of self monitoring of blood glucose (SMBG). The System Usability Scale (SUS), a Theoretical Framework of Acceptability-based questionnaire, the Diabetes Distress Scale (DDS), the Glucose Monitoring Satisfaction Survey (GMSS), and a feasibility survey were administered. Outcomes were summarized descriptively, including means, medians, and frequencies using R statistical software.

Results

The median SUS score was 98.8 (IQR 92.5-100.0). Acceptability was high, and the median total GMSS score improved from 3.73 to 4.73. Among adolescents and adults, the median overall DDS score reduced from 1.54 to 1.36, with reductions in scores in all domains, except for “hypoglycemia distress” which increased, and “physician distress” which remained low. Among caregivers, the median overall DDS score declined from 2.05 (moderate distress) to 1.90 (low distress), with modest reductions in “teen management” and “parent-teen relationship distress” and a slight increase in “personal distress”. Median CGM active wear time was 89%.

Conclusion

This study comprehensively evaluated CGM across usability, acceptability, and feasibility outcomes, with the findings supporting the integration of CGM into routine diabetes management in low-resource settings. The short follow-up period, however, may not capture changing perceptions or long-term adherence.

What is already known on this topic

• Self-monitoring of blood glucose is integral to type 1 diabetes (T1D) management but is associated with pain, inconvenience, and limited ability to capture fluctuations in glucose levels. Continuous glucose monitoring (CGM) offers a solution by providing real-time, minimally invasive glucose measurements, thereby facilitating better diabetes care. However, in low– and middle-income countries CGM is not routinely available, and data on its usability, feasibility, and acceptability remain limited.

What this study adds

• There was high usability, acceptability, and feasibility of CGM among youth with T1D, with sustained engagement, improved glucose monitoring satisfaction, and modest reductions in diabetes distress.

How this study might affect research, practice or policy

• This study’s findings support the wider adoption of CGM for management of youth with T1D in resource-limited settings.