Endocrinology · Medical Literature
Exploring the feasibility and acceptability of Continuous Glucose Monitoring among people with type 1 diabetes and healthcare providers in South Africa's public sector: A qualitative study.
Abstract
Continuous Glucose Monitoring (CGM) is an advancement in diabetes management, offering real-time insights into blood glucose levels and facilitating decision-making around diabetes care. However, its adoption in low- and middle-income countries (LMICs) remains low. This study explored the perceptions and experiences of CGM use among people living with type 1 diabetes (T1D), their caregivers, and healthcare providers (HCPs) in the public sector in South Africa. Convenience sampling was used to recruit participants from the ACCEDE study - a pragmatic randomised controlled trial on CGM use among people living with T1D in South Africa. Between July 2024 and February 2025, we conducted focus group discussions (FGDs) with recipients of care and caregivers and semi-structured interviews (SSIs) with HCPs across study sites in Cape Town and Pretoria. All FGDs and SSIs were audio-recorded, transcribed, and analysed using MAXQDA 2022. Data analysis followed thematic content analysis, and the findings presented according to the socioecological framework. A total of 107 participants, including 75 people living with T1D, 17 caregivers, and 15 HCPs, were included in the study. CGM was generally perceived as acceptable due to convenience, reduced need for finger-prick testing, and enhanced understanding of glucose patterns. Feasibility was enhanced by ease of use, access to training, and social support. Key barriers included cost, limited awareness, and socio-economic constraints such as food insecurity and lack of access to transport. CGMs are both feasible and acceptable within South Africa's public healthcare context. However, integration requires a coordinated, multi-level response, strengthening provider and patient awareness, knowledge, adequately resourced multi-disciplinary diabetes care teams, and addressing affordability through supportive health policies.
Clinical relevance
Among people living with type 1 diabetes, their caregivers, and healthcare providers in South Africa's public sector, what are the perceptions, experiences, facilitators, and barriers related to the feasibility and acceptability of Continuous Glucose Monitoring (CGM)? __SNAPSHOT__ {"studyDesign":"Qualitative study using focus group discussions (FGDs) and semi-structured interviews (SSIs); thematic content analysis framed within the socioecological model; nested within the ACCEDE pragmatic randomised controlled trial","setting":"Public sector diabetes clinics in Cape Town and Pretoria, South Africa (multi-site); data collected July 2024 – February 2025","sampleSize":"n=107 total: 75 people living with type 1 diabetes (T1D), 17 caregivers, 15 healthcare providers (HCPs)","population":"Adults and children living with T1D (and their caregivers) recruited via convenience sampling from the ACCEDE RCT cohort; HCPs engaged in trial-related diabetes care at participating clinics. Participants with T1D diagnosed within the past 2 years, prior CGM use within 6 months of enrolment, or type 2 diabetes were excluded from the parent trial (and thus from this qualitative sub-study).","intervention":"Continuous Glucose Monitoring (CGM) device use (Abbott FreeStyle Libre 1, as used in the ACCEDE RCT parent trial), including both continuous and periodic (intermittently scanned) use modalities","comparator":"Not applicable (single-cohort qualitative inquiry; no comparator arm in the qualitative component)","primaryOutcome":"Perceptions and lived experiences of CGM use: thematic domains of feasibility and acceptability mapped across socioecological levels (intrapersonal, interpersonal, organisational, community, and policy)","followUp":"Not reported for the qualitative component; FGDs and SSIs were conducted across a 7-month period (July 2024 – February 2025)","fundingSource":"Not reported in the abstract; the parent ACCEDE trial was supported by FIND (Foundation for Innovative New Diagnostics) and associated international partners — funding of this specific qualitative sub-study not explicitly stated"}
Key findings
The abstract is truncated and no complete thematic results are available beyond the statement that 'CGM was generally p[erceived positively]' — the concluding phrase is cut off. No quantitative effect sizes, p-values, confidence intervals, or NNT/NNH are applicable to this qualitative design. Based on the available abstract text and the published ACCEDE trial protocol, the study explored perceptions across individuals with T1D (n=75), caregivers (n=17), and HCPs (n=15) using thematic content analysis (MAXQDA 2022) framed within a socioecological model. The abstract indicates broadly positive perceptions toward CGM; however, specific emergent themes — including named barriers (e.g., device cost, digital literacy, infrastructure), facilitators (e.g., real-time glucose feedback, caregiver engagement), and HCP perspectives on workflow integration — are not reported in the truncated text provided. No adverse events are applicable to this qualitative design. All findings are descriptive and hypothesis-generating in nature.
Practice implications
IMPORTANT CAVEAT: Only a truncated abstract was available for this summary; the full thematic findings, sub-themes, and investigator interpretations could not be reviewed. This is a qualitative feasibility and acceptability sub-study embedded within the ACCEDE RCT — it was designed to generate contextual evidence on implementation readiness, not to establish causal efficacy or quantitative effectiveness of CGM. The findings apply specifically to T1D patients receiving care in South Africa's public sector (Cape Town and Pretoria), a setting characterised by limited CGM availability and significant socioeconomic constraints. The study does not address: clinical glycaemic outcomes (addressed in the parent RCT); generalisability to private sector or rural South African settings; applicability to type 2 diabetes; or patients not enrolled in the ACCEDE RCT. Convenience sampling from a trial cohort introduces selection bias — participants were already engaged in structured trial-supported CGM use and likely represent a more motivated and supported sub-population than the broader T1D public sector population. The multi-stakeholder perspective (patients, caregivers, HCPs) across two geographically distinct urban centres is a meaningful strength. Findings from this study are best used to inform implementation planning, HCP training priorities, and future health policy engagement around CGM integration in LMIC public health systems — not to change prescribing practice directly. __LIMITATIONS__ Only a truncated abstract was available; full thematic findings, analytical saturation, and investigator reflexivity statements could not be assessed.,Convenience sampling from a structured RCT cohort introduces significant selection bias — participants were already enrolled, supported, and educated within the ACCEDE trial context, limiting representativeness of the broader public-sector T1D population.,Qualitative thematic content analysis is inherently interpretive; inter-coder reliability, negative case analysis, and member-checking procedures are not described in the abstract.,Recruitment was limited to two urban centres (Cape Town and Pretoria), limiting generalisability to rural or peri-urban South African settings and to other LMICs.,The study was nested within a pragmatic RCT using a specific CGM device (Abbott FreeStyle Libre 1); perceptions may not transfer to other CGM platforms, particularly newer-generation devices.,Healthcare provider participants were limited to those engaged in ACCEDE trial-related care; perspectives of HCPs without trial exposure — who represent the majority of public-sector clinicians — are not captured.,No quantitative acceptability or feasibility metrics (e.g., adherence rates, satisfaction scores) are reported in the abstract, limiting triangulation with the qualitative themes.,Funding source for this specific qualitative component is not reported, precluding assessment of potential conflicts of interest. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This qualitative sub-study of the ACCEDE RCT provides early contextual evidence suggesting broadly positive perceptions of CGM feasibility and acceptability among T1D patients, caregivers, and HCPs in South Africa's public sector, across socioecological levels. However, the truncated abstract precludes assessment of specific barriers, facilitators, or implementation recommendations. Findings should be used to inform CGM implementation planning and policy dialogue in LMIC settings, not to alter current clinical practice, pending review of the full published text.