Feasibility and benefits of continuous glucose monitoring for type 1 diabetes in Rwanda: A real-world 12-month continuation phase.
Academic Article
Overview
abstract
AIMS: Continuous glucose monitoring (CGM) remains underutilized in low- and middle-income countries (LMICs). We extend earlier observations on the feasibility and impact of CGM among people living with type 1 diabetes (T1D) in Rwanda in a real-world continuation phase study. METHODS: This was a 1-year continuation phase of a single-arm, mixed-methods, prospective observational study conducted in Kigali, Rwanda, from August 2022 to September 2024. Completers of the 12-month Phase I were transitioned to a current-generation CGM device and, in months 19-24, reduced frequency of clinic visits reflecting routine care. The primary outcomes were change in haemoglobin A1c (HbA1c) and the CGM-based metrics time in range (TIR, 3.9-10 mmol/L), and time below range (TBR, <3.9 mmol/L). Secondary outcomes included self-reported hospitalizations, incidences of severe hypoglycaemia and diabetic ketoacidosis, as well as diabetes-related questionnaire results. RESULTS: At the end of Phase I, 40 of the original 50 participants entered Phase II with mean HbA1c, TIR and TBR of 44 mmol/mol (6.2%), 44.9% and 5.6%, respectively, all metrics being significantly different from study start. These did not change significantly by the end of the study (48 mmol/mol [6.6%], 46.5% and 7.9%, respectively). No hospitalizations, three episodes of severe hypoglycaemia and two episodes of diabetic ketoacidosis were reported. Most respondents were satisfied with the device, used it consistently and trusted the values provided. CONCLUSIONS: CGM-related improvements in HbA1c and TIR among Rwandans living with T1D were maintained for at least 24 months. CGM should be considered as an important tool to improve diabetes self-management in LMICs.
