Use of continuous glucose monitors in low‐ and middle‐income countries: A scoping review

Abstract

Aims:The use of continuous glucose monitors (CGMs) has been shown to have positive impact on diabetes management for people with type 1 diabetes (T1DM), type 2 diabetes (T2DM) and gestational diabetes (GDM) in high-income countries. However, as useful as CGMs are, the experience in low-and middle-income countries (LMICs) is limited and has not been summarized. Methods:A scoping review of the scientific literature was conducted. Medline, Embase, Global Health and Scopus were used to seek original research conducted in LMICs. The search results were screened by two reviewers independently. We included studies assessing health outcomes following the use of CGMs at the individual level (e.g. glycaemic control or complications) and at the health system level (e.g. barriers, facilitators and cost-effectiveness) in English, Portuguese, Spanish and French. Results were summarized narratively.Results: From 4772 records found in database search, 27 reports were included; most of them from China (n = 7), Colombia (n = 5) and India (n = 4). Thirteen reports studied T1DM, five T2DM, seven both T1DM and T2DM and two GDM.Seven reports presented results of experimental studies (five randomized trials and two quasi-experimental); two on cost-effective analysis and the remaining 18 were observational. Studies showed that CGMs improved surrogate glycaemic outcomes (HbA 1c reduction), hard endpoints (lower hospitalization rates and diabetes complications) and patient-oriented outcomes (quality of life). However, several caveats were identified: mostly observational studies, few participants in trials, short follow-up and focused on surrogate outcomes. Conclusions:The scoping review identified that studies about CGMs in LMICs have several limitations. Stronger study designs, appropriate sample sizes and the inclusion of patient-important outcomes should be considered to inform the evidence about CGMs for the management of people with diabetes in LMICs.

Implementation research: a protocol for two three-arm pragmatic randomised controlled trials on continuous glucose monitoring devices in people with type 1 diabetes in South Africa and Kenya

“…However, this body of evidence consists primarily of studies conducted in the United States (US) [ 1 , 3 , 4 ], Europe [ 1 , 2 ], or Australia [ 1 ], and there are limited data on the effects of CGM on clinical outcomes in low- and middle-income countries (LMICs), where CGM devices may not be readily available. A recent scoping review of CGM in LMICs did not identify any randomised trial conducted in Sub-Saharan Africa [ 5 ], and to our knowledge only one study on the use of CGM in people with T1D has been conducted in the region, which was a feasibility study in Kenya and Uganda and not a randomised control trial [ 6 ]. Similarly, we have identified no randomised trials conducted in South Africa that have evaluated the impact of CGM compared with standard of care glucose monitoring on HbA1c (and other clinical outcomes) in people with T1D, with the majority of the evidence base consisting of qualitative, mixed methods, and perception studies [ 7 – 10 ].…”