Bittersweet: the untapped potential of continuous glucose monitoring for diabetes

By Nikhita Gopisetty, Riva Greenberg & Lejla Druškić Mustafić*

After 10 years of daily finger pricks, a two-week trial of a continuous glucose monitor (CGM) was a game-changer for Newton*, living with type 1 diabetes (T1D) in Kenya. He was amazed by all the data points, which offered him unprecedented insights into his blood glucose levels throughout the day and night. Not only did this enable him to optimize his insulin regimen, it also helped him to understand better how different foods impact his glucose levels, and the effects of his glucose level on his productivity at work.

Living with T1D anywhere is no simple feat, but it has been made easier with advances in technology innovations. CGMs have become the standard of care for T1D management in high-income countries, but they are largely inaccessible to most people living in low- and middle-income countries (LMICs), including Newton’s home of Kenya. As much as Newton loved his experience with a CGM, he simply cannot afford to continue using one after the trial was over.

One in five people living with T1D live in LMICs, where the life expectancy with this condition is significantly lower than elsewhere. In resource-constrained environments, individuals with T1D face unique hardships. Inconsistent access to insulin, glucose testing supplies, and healthcare infrastructure make adequate glucose management nearly impossible. Without it, most people with T1D in LMICs accumulate life-threatening complications over time and die prematurely.

Anita* has been using a CGM in Indonesia since 2015, but as manufacturers have not officially entered the market in that country, she can only access the device and supplies through informal channels. As a result, availability of supplies is fragile, and in volatile circumstances including the COVID-19 pandemic, she has been forced to revert to manual monitoring, prohibiting consistency in her management. Moreover, Anita has not been able to find a diabetes specialist who can interpret her CGM data because they are not a standard of care in her country, making her resort to the online community for management support.

Similarly, Thapi*, in South Africa, has lived with T1D for nearly 2 decades and has been using a CGM for the last 4 years. She also feels the relative scarcity of diabetes specialists in her country, requiring her to travel further to meet with a healthcare professional who can interpret the data from her CGM.

While progress in CGM availability has been made in some LMICs, T1D care goes beyond access to new technologies. Thapi points out the technical inadequacies of some CGMs, with the adhesive used to make them stay in place for the entire wear time not being fit for warmer and more humid climates.

The collective experiences of Newton, Anita, and Thapi underscore that CGMs, as they currently stand, are not supported to withstand the unique challenges of low-resource settings. It is critical that CGM manufacturers register in more countries to address availability, take into consideration local affordability and design their technologies to accommodate people and circumstances in LMICs. A so-called “target product profile” which lays out the ideal characteristics of CGMs destined for use in LMICs has been recently developed by a panel of experts with extensive input from people with lived experience of diabetes.

National health systems also need to recognize that people living with diabetes in their countries are now starting to use CGMs, and thus require their health providers to be able to deal with the data. Thapi and Anita found that relying on online diabetes communities and platforms to navigate the intricacies of their CGMs can leave them isolated in their diabetes management, as the relationship and trust in health providers is recognized to be vital for management.

Empowering healthcare professionals with the knowledge and expertise to support CGM utilization is essential. Investments in training offer a multitude of long-term benefits, including cost-effectiveness and improved health outcomes for people living with T1D. The ripple effect extends to better productivity, reduced healthcare costs, and, most importantly, enhanced quality of life for people living with T1D around the world.

Access to better management for T1D is a collective endeavor that demands collaboration among governments, national and international organizations, and local communities. By working hand in hand, we can create a world where every individual with T1D has access to the life-changing benefits of CGMs and is empowered to manage their condition with the support of their healthcare professionals and communities.

*Newton, Anita and Thapi kindly agreed to the authors sharing their stories in this article.

Nikhita Gopisetty is a Master’s of Science candidate in Global Health at Duke University, T1D advocate, and part of the non-communicable diseases programme team at FIND.

Riva Greenberg shares a flourishing approach to living with diabetes, is a global diabetes advocate, author and speaker.

Lejla Druškić Mustafić is a nurse, T1D advocate, and consultant at FIND.

This op-ed was published in Pan African Visions, 14 November 2023