Acceptability of and Barriers to Continuous Glucose Monitoring in Individuals with Type 2 Diabetes Mellitus Receiving Chronic Hemodialysis: Research Letter

Continuous glucose monitoring (CGM) in individuals receiving hemodialysis is more accurate than hemoglobin A1 c (HbA1 c ) and may improve diabetes management in this population, but little is known regarding patient perspectives on CGM technology and its use in clinical outpatient hemodialysis care. We aimed to explore the real-world acceptability of CGM use in nonhospitalized individuals receiving hemodialysis. This pragmatic prospective observational study was nested within a qualitative improvement initiative that embedded an endocrinologist providing care for people with type 2 diabetes mellitus and HbA1 c greater than 8% within the hemodialysis unit. As part of this initiative, some people seen by the endocrinologist were prescribed CGMs. These individuals were approached to participate in the study and followed for 2 weeks during CGM wear. Reasons for CGM decline were collected and collated inductively using content analysis. Of 47 consults, only 22 (47%) people were prescribed CGM. Of these, six (27%) declined CGM use and only six (27%) consented to the study, but ultimately only three participants (13.6%) completed the study. Reasons for CGM decline included lack of comfort with technology, cost and poor cellphone, internet and data availability. Our findings suggest that further exploration of barriers to CGM use and solutions to these barriers is required prior to broad use of CGM in real-world outpatient hemodialysis settings.