Acceptability, feasibility, quality of life and diabetes distress score outcomes: A pragmatic randomised clinical trial on continuous glucose monitoring for people with type 1 diabetes
Abstract
IntroductionContinuous glucose monitoring (CGM) offers an advancement over traditional self-monitoring of blood glucose (SMBG) for people living with type 1 diabetes (T1D). However, evidence on the acceptability and feasibility of different CGM use cases in African populations remains limited.
MethodsThis was a pragmatic three-arm, randomised controlled trial on CGM conducted among people living with T1D in three public healthcare clinics in South Africa. Participants were assigned to Arm 1 (continuous CGM), Arm 2 (periodic CGM), or Arm 3 (SMBG). Diabetes education was provided at all study visits. Feasibility was assessed by adherence to CGM use and through the Glucose Monitoring Satisfaction Survey (GMSS). Diabetes distress was measured by the Diabetes Distress Scale (DDS), health-related quality of life (HRQoL) by the EQ-5D scales, and acceptability using the Theoretical Framework of Acceptability (TFA). Surveys were collected on paper and transferred to OpenClinica. Analyses were performed in R. The trial was registered in the Clinical Trials Registry (NCT05944718) on July 13, 2023.
ResultsA total of 83 participants were included in Arm 1, 85 in Arm 2, and 80 in Arm 3. CGM mean active time was 55% in Arm 1 versus 69% in Arm 2. The proportion of participants meeting the [≥]70% active time threshold was higher in Arm 2 (52%) than in Arm 1 (34%). Diabetes distress declined across arms during the intervention period, with no significant difference between arms; distress increased slightly six months post-intervention but remained below baseline. At 6 months, glucose monitoring satisfaction was significantly higher in both CGM arms than in the SMBG arm, and satisfaction increased over time in CGM arms. Health-related quality of life remained stable across arms during the intervention period with no significant difference between arms. High acceptability was observed in both CGM arms, with higher ratings in the periodic arm.
ConclusionsCGM was acceptable to people living with type 1 diabetes and feasible to use in public-sector clinics in South Africa, with high acceptability under continuous and periodic use. Health-related quality of life remained stable across arms, and diabetes-related distress declined, during the intervention period, across arms. Glucose monitoring satisfaction rose significantly in both CGM arms compared to SMBG. Periodic CGM might be a promising and potentially more scalable option than continuous use for public-sector care.
Clinical Trials registration: NCT05944718
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BibTeX
@misc{marbancastro2026acceptability,
title = {{Acceptability, feasibility, quality of life and diabetes distress score outcomes: A pragmatic randomised clinical trial on continuous glucose monitoring for people with type 1 diabetes}},
author = {E. Marban-Castro and L. Muhwava and S. Girdwood and T. Kemp and J. Freitas and Y. Kamau and M. Otieno and D. Akach and A. Morato and S. Sanz and V. Fiechter and B. Erkosar and M. Watson and B. Vetter and C. Haldane and S. Shilton and P. Rheeder and J. A. Dave and M. Carrihill and M. Karsas},
howpublished = {medRxiv},
year = {2026},
month = aug,
doi = {10.64898/2026.08.26.26361479},
url = {https://www.medrxiv.org/content/10.64898/2026.08.26.26361479v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Acceptability, feasibility, quality of life and diabetes distress score outcomes: A pragmatic randomised clinical trial on continuous glucose monitoring for people with type 1 diabetes
AU - E. Marban-Castro
AU - L. Muhwava
AU - S. Girdwood
AU - T. Kemp
AU - J. Freitas
AU - Y. Kamau
AU - M. Otieno
AU - D. Akach
AU - A. Morato
AU - S. Sanz
AU - V. Fiechter
AU - B. Erkosar
AU - M. Watson
AU - B. Vetter
AU - C. Haldane
AU - S. Shilton
AU - P. Rheeder
AU - J. A. Dave
AU - M. Carrihill
AU - M. Karsas
PY - 2026
DA - 2026/08/26
PB - medRxiv
DO - 10.64898/2026.08.26.26361479
UR - https://www.medrxiv.org/content/10.64898/2026.08.26.26361479v1
AB - IntroductionContinuous glucose monitoring (CGM) offers an advancement over traditional self-monitoring of blood glucose (SMBG) for people living with type 1 diabetes (T1D). However, evidence on the acceptability and feasibility of different CGM use cases in African populations remains limited. MethodsThis was a pragmatic three-arm, randomised controlled trial on CGM conducted among people living with T1D in three public healthcare clinics in South Africa. Participants were assigned to Arm 1 (continuous CGM), Arm 2 (periodic CGM), or Arm 3 (SMBG). Diabetes education was provided at all study visits. Feasibility was assessed by adherence to CGM use and through the Glucose Monitoring Satisfaction Survey (GMSS). Diabetes distress was measured by the Diabetes Distress Scale (DDS), health-related quality of life (HRQoL) by the EQ-5D scales, and acceptability using the Theoretical Framework of Acceptability (TFA). Surveys were collected on paper and transferred to OpenClinica. Analyses were performed in R. The trial was registered in the Clinical Trials Registry (NCT05944718) on July 13, 2023. ResultsA total of 83 participants were included in Arm 1, 85 in Arm 2, and 80 in Arm 3. CGM mean active time was 55% in Arm 1 versus 69% in Arm 2. The proportion of participants meeting the [≥]70% active time threshold was higher in Arm 2 (52%) than in Arm 1 (34%). Diabetes distress declined across arms during the intervention period, with no significant difference between arms; distress increased slightly six months post-intervention but remained below baseline. At 6 months, glucose monitoring satisfaction was significantly higher in both CGM arms than in the SMBG arm, and satisfaction increased over time in CGM arms. Health-related quality of life remained stable across arms during the intervention period with no significant difference between arms. High acceptability was observed in both CGM arms, with higher ratings in the periodic arm. ConclusionsCGM was acceptable to people living with type 1 diabetes and feasible to use in public-sector clinics in South Africa, with high acceptability under continuous and periodic use. Health-related quality of life remained stable across arms, and diabetes-related distress declined, during the intervention period, across arms. Glucose monitoring satisfaction rose significantly in both CGM arms compared to SMBG. Periodic CGM might be a promising and potentially more scalable option than continuous use for public-sector care. Clinical Trials registration: NCT05944718
ER -