Barchiesi Maria Assunta, Calabrese Armando, Costa Roberta, Pillo Francesca Di, D'Uffizi Antonio, Tiburzi Luigi, Zahid Erum
Department of Enterprise Engineering "Mario Lucertini", University of Rome "Tor Vergata", Italy.
Department of Computer, Control, and Management Engineering of Sapienza university of Rome, Italy.
Int J Qual Health Care. 2025 May 8. doi: 10.1093/intqhc/mzaf046.
Diabetes mellitus, particularly type 2 diabetes (T2DM), is a chronic disease associated with serious complications, such as heart disease, kidney failure, and blindness. Continuous glucose monitoring (CGM) systems have emerged as a more effective alternative to traditional fingerstick testing, offering patients greater control over their condition. Despite their potential benefits, several barriers to CGM sensor use persist, limiting their widespread adoption among patients with T2DM. This review explores the barriers to CGM sensor use, particularly from the patient's perspective.
A systematic literature review is conducted following PRISMA guidelines. The search focuses on studies published between January 2018 and June 2024 and is performed in two primary databases, PubMed and Scopus, selected for their relevance to Type 2 diabetes research. Studies are included if they explore challenges and barriers to CGM adoption, report patient perspectives, or provide insights into the usability and accessibility of technology. The data is analysed using deductive content analysis, applying Wilson et al.'s thematic categories as a predefined framework to systematically classify and interpret barriers to CGM adoption. This approach ensures methodological consistency and alignment with existing research on eHealth adoption challenges.
The review identifies several key barriers to CGM sensor use despite the benefits, such as improved glucose control and reduced hypoglycaemic events. Major challenges include the high cost of sensors, wearability issues, discomfort from adhesive materials, and concerns about the visibility of the sensors. Additionally, patients report difficulties in interpreting the large volumes of data generated by CGMs, as well as discomfort or fear related to sensor insertion. Lack of technological support, low health literacy, and insufficient social support are also identified as factors contributing to non-adoption.
Policymakers and healthcare providers are encouraged to address these barriers by developing patient-centred strategies that support the adoption of CGM sensors. Successfully overcoming these challenges can further support integrating CGM sensors with the Chronic Care Model (CCM) and Automated Insulin Delivery (AID) systems. As an implication, this integration has the potential to enhance glycemic control and improve patient quality of life in the management of Type 2 diabetes. Furthermore, addressing these barriers may drive advancements in sensor design, improve accessibility, and minimize the environmental impact of CGM sensor use.
糖尿病，尤其是2型糖尿病（T2DM），是一种与严重并发症相关的慢性疾病，如心脏病、肾衰竭和失明。连续血糖监测（CGM）系统已成为传统指尖采血检测的一种更有效的替代方法，能让患者更好地控制病情。尽管其有潜在益处，但CGM传感器的使用仍存在一些障碍，限制了其在T2DM患者中的广泛应用。本综述探讨了CGM传感器使用的障碍，特别是从患者的角度。
按照PRISMA指南进行系统的文献综述。搜索重点是2018年1月至2024年6月期间发表的研究，在两个主要数据库PubMed和Scopus中进行搜索，选择这两个数据库是因其与2型糖尿病研究的相关性。如果研究探讨了CGM采用的挑战和障碍、报告了患者的观点或提供了关于技术可用性和可及性的见解，则纳入研究。使用演绎性内容分析对数据进行分析，将Wilson等人的主题类别作为预定义框架，以系统地分类和解释CGM采用的障碍。这种方法确保了方法的一致性，并与现有关于电子健康采用挑战的研究保持一致。
该综述确定了尽管CGM传感器有诸多益处，但在使用方面仍存在几个关键障碍，如改善血糖控制和减少低血糖事件。主要挑战包括传感器成本高、可穿戴性问题、粘贴材料带来的不适以及对传感器可见性的担忧。此外，患者报告难以解读CGM产生的大量数据，以及与传感器插入相关的不适或恐惧。缺乏技术支持、健康素养低和社会支持不足也被确定为导致不采用的因素。
鼓励政策制定者和医疗保健提供者通过制定以患者为中心的策略来解决这些障碍，以支持CGM传感器的采用。成功克服这些挑战可以进一步支持将CGM传感器与慢性护理模式（CCM）和自动胰岛素输送（AID）系统相结合。这意味着，这种整合有可能在2型糖尿病管理中加强血糖控制并改善患者生活质量。此外，解决这些障碍可能推动传感器设计的进步，提高可及性，并最大限度地减少CGM传感器使用对环境的影响。
