JMIR Publications

ABSTRACT

Background:

Despite the existence of an increasing array of digital technologies and tools for diabetes management, there are disparities in access to and uptake and use of continuous glucose monitoring (CGM) devices, particularly for those most at risk for poor diabetes outcomes.

Objective:

To assess communication technology and continuous glucose monitoring (CGM) access, literacy, and use among patients receiving treatment for diabetes at an inner-city safety-net hospital.

Methods:

A survey on digital technology ownership and use was self-administered by 75 adults with type 1 (T1D) and type 2 (T2D) diabetes at the diabetes clinic of Grady Memorial Hospital in Atlanta, GA. In-depth interviews (IDI) were conducted with 12 of these patient participants and with six providers to provide additional insights into the use of communication technology and CGM to support diabetes self-management.

Results:

Most participants were African American (88%); over half were unemployed or working part-time; 29% had no health insurance coverage while 61% had federal coverage. Smartphone ownership and use were near universal; texting and email use were common (84%). Ownership and use of tablets and computers and use and daily use of various forms of media were more prevalent among younger participants and those with T1D, who also rated them easier to use. Technology use specifically for diabetes and health management was low. Participants were supportive of a potential smartphone app for diabetes management, with a high interest in such an app helping them to track blood sugar levels and communicate with their care teams. Younger participants indicated higher levels of interest, perceived value, and self-efficacy for using an app with these capabilities. History of CGM use was reported by 56% of participants, though half had discontinued use, above all due to the cost of the device and issues with its adhesive. Non-use was primarily due to not being offered CGM. Reasons given for continued use included convenience, improved blood glucose control, and better tracking of blood glucose. IDIs (n=18) revealed high levels of satisfaction with CGM by users and supported the survey findings regarding reasons for continued use. These also highlighted the value of CGM data to enhance communication between patients and providers.

Conclusions:

Smartphone ownership is near universal among patients receiving care at an inner-city hospital. Alongside the need to address barriers to CGM access and continued use, there is an opportunity to leverage increased access to communication technology in combination with CGM to improve diabetes outcomes among under-resourced populations.