JMIR Publications

ABSTRACT

Background:

Remote glucose monitoring (RGM) has been shown to improve diabetes self-management by providing patients and clinicians with access to glucose data between scheduled visits, resulting in changes to management strategies. However, how implementation and engagement in safety-net settings is shaped by contextual, technological, and policy-related barriers are under explored.

Objective:

To identify facilitators and barriers to RGM implementation and engagement in an urban safety-net health system and to examine how these factors interact across multiple levels of care delivery.

Methods:

We conducted a convergent mixed methods study as part of the Improving Diabetes Equity and Advancing Care (IDEA) study at an endocrinology clinic within a safety-net health system. Data were obtained from four patient focus groups (n=15), staff interviews (n=8), weekly study team meeting notes, and patient acceptability survey data. Quantitative data were summarized descriptively. Qualitative data were analyzed using the Consolidated Framework for Implementation Research (CFIR), and findings were integrated to develop metainferences across data sources. The study was approved by the Mount Sinai Hospital Institutional Review Board.

Results:

Fifty-seven participants from the parent study were randomized to the RGM arm. Forty-eight (84%) successfully transmitted glucose data to the diabetes management platform, and 80% of surveyed participants reported that the platform met their approval. We identified 16 facilitators and 18 barriers to RGM implementation and utilization across the five CFIR domains. Facilitators included improved care coordination, access to longitudinal glucose data, shared decision-making, interdisciplinary teamwork, and vendor partnerships that reduced organizational burden. Barriers included low digital literacy, trust concerns, alert fatigue, workflow inefficiencies, lack of standardized protocols, staffing limitations, technical complexity, vendor support issues, and insurance-related restrictions that limited access to compatible devices. Many barriers interacted across patient, organizational, innovation, and outer-setting levels, reducing the feasibility and perceived value of RGM despite strong interest from both patients and staff.

Conclusions:

RGM has potential to improve diabetes care in safety-net settings, but successful implementation requires attention to multilevel barriers. Clear workflows, adequate staffing, tailored training, responsive vendor support, and policy changes that improve equitable access to devices are needed to support sustained RGM use. These findings offer actionable guidance for health systems planning to implement remote monitoring interventions in resource-constrained settings. Clinical Trial: This trial is registered with ClinicalTrials.gov, NCT06040463