Acceptability, Feasibility, and User Experiences of Continuous Glucose Monitoring in Type 1 Diabetes in Kenya: Perspectives of Adolescents, Young Adults, Caregivers, and Healthcare Providers

Living with type 1 diabetes is a constant, demanding negotiation between the body and the outside world. People with this condition must carefully balance insulin, food, and activity to keep their blood sugar levels within a safe range. Without this balance, the body can swing into dangerous highs or life-threatening lows. For decades, the standard way to manage this risk has been the finger-prick test. Several times a day, a person must prick their finger, apply a drop of blood to a small strip, and wait for a machine to give a single number. This method tells them where their sugar is at that exact moment, but it leaves them in the dark about what happens between the tests. It offers no warning if sugar is about to drop suddenly, and the repeated pricking can be painful and discouraging, especially for children and teenagers trying to grow up normally.

In recent years, a different tool has emerged to fill these gaps: continuous glucose monitoring. This technology uses a tiny sensor placed just under the skin to measure sugar levels every few minutes, sending the data to a receiver or a smartphone. Instead of a single snapshot, it provides a moving picture of how sugar rises and falls throughout the day and night. While this technology has become common in wealthy nations, its role in lower-resource settings remains unclear. The cost of the sensors, the need for reliable electricity to charge devices, and the lack of trained medical staff have made many wonder if this advanced tool can truly work for families in places like Kenya. Understanding whether people can actually use these devices in their daily lives, and whether they find them helpful enough to keep using them, is essential before they can become a standard part of care.

Researchers in Nairobi set out to answer these questions by listening directly to the people who would be using the technology. They worked with a group of forty people living with type 1 diabetes, including teenagers, young adults, and the parents who care for them, along with the doctors and nurses who treat them. For a period of time, these participants used a specific type of continuous glucose monitor provided free of charge. After they had worn the devices for several weeks, the researchers gathered them into small groups to talk about their experiences. They asked the teenagers and young adults how the device fit into their school and social lives. They asked the parents how it changed their daily routines and their peace of mind. They also asked the medical staff how the new data helped them make treatment decisions. The goal was not just to see if the machines worked, but to understand how they felt in the hands of real people facing real challenges.

The conversations revealed a profound shift in how these families experienced their daily struggle. For the teenagers and young adults, the most immediate change was the end of the painful finger pricks. They described the old method as a source of fear and physical discomfort, noting that the constant need to prick their fingers made them feel different from their peers. The new sensor, which they scanned with a reader or phone, was painless and discreet. One young person noted that they could check their sugar levels without anyone noticing, a significant relief in a school environment where standing out can be difficult. The device also provided a safety net that the old method could not. Participants spoke with genuine relief about the alarms that warned them when their sugar was dropping too low, often before they even felt the symptoms. This was particularly important at night, when parents no longer had to wake their sleeping children to check a number, and when teenagers could sleep without the fear of a dangerous drop going unnoticed.

For the parents, the device transformed the emotional landscape of caregiving. Many described the old routine as a source of constant anxiety and conflict, especially when trying to get children to cooperate with painful tests. The new technology reduced this friction. Parents found they could see the trends of their children's sugar levels, which helped them understand patterns rather than just reacting to single numbers. This visibility allowed them to have more informed conversations with their children and their doctors. Instead of guessing whether a child had taken their insulin or eaten the right food, parents could see the data and work together with their children to solve problems. The device also eased the burden on parents who often had to leave work or run to school to check on their children, as the remote monitoring capabilities meant they could keep an eye on things from a distance.

The medical staff, who had previously seen these devices only in stories or on social media, found them to be a powerful addition to their clinical toolkit. Before the study, many doctors and nurses assumed the technology was too complex or too expensive to be useful in their setting. Once they began reviewing the detailed graphs and patterns provided by the sensors, they realized how much more information they had to guide their treatment. They could see exactly when a patient's sugar was spiking or dropping and discuss the specific causes with the family. This led to more precise adjustments in insulin doses and better overall control of the disease. The staff noted that patients who used the device often showed improved health markers, suggesting that the technology helped them manage their condition more effectively than before.

Despite these clear benefits, the study also highlighted a significant barrier that could prevent this technology from becoming a standard part of care for everyone. The participants and the medical staff were unanimous in their view that the cost of the sensors was the main obstacle to long-term use. The sensors need to be replaced every two weeks, and the price for a month's supply was described as far beyond the reach of most families in Kenya. One parent calculated that the monthly cost could equal a significant portion of a typical family's income, making it impossible to sustain without outside financial help. While the technology worked well and was loved by those who used it, the researchers concluded that without a way to make it affordable, it would remain a privilege for a few rather than a tool for the many.

The study also touched on the social and practical challenges of living with the device. Some teenagers felt self-conscious when the sensor was visible under their clothes, leading to questions from friends or even fear that the device might be dangerous. Parents reported that they had to educate their extended families and neighbors to dispel myths about the technology. There were also minor technical issues, such as the sensor occasionally falling off or causing skin irritation, but these were generally manageable and did not stop people from using the device. The researchers found that with proper training and support, both the patients and the medical staff could overcome these hurdles. The key to success was not just the device itself, but the network of support around it, including educated teachers, understanding families, and trained healthcare providers.

Ultimately, the research suggests that continuous glucose monitoring is a highly acceptable and useful tool for managing type 1 diabetes in Kenya. It offers a way to reduce pain, improve safety, and empower families to take control of their health. The technology proved to be feasible in a low-resource setting, provided that the users had the necessary training and support. However, the path forward is blocked by the high cost of the sensors. The researchers emphasize that for this technology to truly benefit the people who need it most, efforts must be made to improve affordability and availability. Without addressing the financial barrier, the potential of this life-changing tool will remain out of reach for the vast majority of families living with type 1 diabetes in similar settings.