The application of integration of Continuous Glucose Monitoring (CGM) data on improving telehealth outcomes in long-term diabetic care in the Indian healthcare system

Abstract

India is grappling with a growing diabetes epidemic, with the prevalence of diabetes among adults (aged ≥20 years) as reported by Anjana et al. (2022) being 11.4% and the delivery of diabetes care still revolving around episodic visits to clinics. While Continuous Glucose Monitoring (CGM) and telehealth have both demonstrated clinical utility, empirical studies in India have not explored how they can be combined. Four objectives were identified for this study related to integration in practice, integration in decision making and continuity, patient engagement and outcomes, and barriers to integration, to evaluate the impact of CGM integration in telehealth platforms on long term diabetes management in India. This positivist, deductive, cross-sectional online survey was sent to individuals in the Indian diabetes care, telehealth and digital health professions using LinkedIn. Forty-two responses, out of a total of 44, were analysed after discarding 2 responses that failed to meet the inclusion criteria, using a formula based workbook in Microsoft Excel. The statistical analyses performed were frequencies with Likert summary statistics and inferential statistics were done using Pearson chi-square, Fisher's Exact Test and Spearman's rank-order correlation. When it comes to use of CGM data for telehealth, most respondents (81%) reported using it rarely or sometimes at best and 57.5% said it improves long-term management. Three significant correlations of high magnitude were found: decision-making with continuity (ρ = 0.66, p < 0.001); engagement with outcomes (ρ = 0.77, p < 0.001); and infrastructure with privacy concerns (ρ = 0.65, p < 0.001). The most frequently cited challenges were low patient digital literacy (59.5%), high device cost (47.6%) and limited insurance coverage (35.7%). These results indicate that while there is a wide acceptance of the clinical case for the integration of CGM and telehealth, practical hurdles are mostly on the patient side and economic factors rather than the clinician's side