CONTINUOUS GLUCOSE MONITORING AS AN INNOVATIVE DIGITAL HEALTH TECHNOLOGY IN TYPE 1 DIABETES: PSYCHOSOCIAL BARRIERS, PHYSICAL ACTIVITY AND EQUITY OF ACCESS

Authors

DOI:

https://doi.org/10.31435/ijitss.3(51).2026.5803

Keywords:

Type 1 Diabetes, Physical Activity, Continuous Glucose Monitoring, Quality of Life, Health Equity

Abstract

Research objectives. While CGM plays an essential role in managing the modern type one diabetic's condition it becomes most critical for those with type 1 diabetes who engage in physical activity as they are often fearful of experiencing low blood glucose levels (hypoglycemia) or post-exercise elevated glycemic levels (dysglycemia), which can limit their ability to participate in such activities. To conduct a focused evaluation of the recent evidence-based research regarding the psychosocial and access related aspects of using Continuous Glucose Monitoring (CGM) technology among physically active individuals with type 1 diabetes.

Methods. Using a focused search strategy that included articles from peer-reviewed journals indexed within MEDLINE/PubMed published between 2022 and 2026 this article has reviewed the original evidence-based research.

Key findings. There is strong evidence concerning exercise related safety, the immediate nature of clinical decision making and fear of experiencing low blood glucose (hypoglycaemia) when exercising. Alerts for predictive post-exercise hypoglycaemic events and the use of CGM that includes information on exercise can both potentially be effective at reducing episodes of clinically significant post-exercise hypoglycaemia. Generic quality of life and diabetes distress have very little direct evidence available regarding these as outcomes in physically active populations.

Conclusions. CGM provides meaningful clinical support for safer exercise in type 1 diabetes. However, it is insufficient to overcome behavioural barriers by itself. Inequitable access to CGM represents a major barrier to achieving its potential benefit in the "real world".

References

American Diabetes Association Professional Practice Committee. (2025). 5. Facilitating positive health behaviors and well-being to improve health outcomes: Standards of care in diabetes—2025. Diabetes Care, 48(Suppl. 1), S86–S127. https://doi.org/10.2337/dc25-S005

American Diabetes Association Professional Practice Committee. (2026). 7. Diabetes technology: Standards of care in diabetes—2026. Diabetes Care, 49(Suppl. 1), S150–S165. https://doi.org/10.2337/dc26-S007

Been, R. A., Lameijer, A., Gans, R. O. B., van Beek, A. P., Kingsnorth, A. P., Choudhary, P., & van Dijk, P. R. (2024). The impact of socioeconomic factors, social determinants, and ethnicity on the utilization of glucose sensor technology among persons with diabetes mellitus: A narrative review. Therapeutic Advances in Endocrinology and Metabolism, 15, 20420188241236289. https://doi.org/10.1177/20420188241236289

Bisno, D. I., Reid, M. W., Pyatak, E. A., Flores Garcia, J., Salcedo-Rodriguez, E., Torres Sanchez, A., Fox, D. S., Hiyari, S., Fogel, J. L., Marshall, I., Bachmann, G., & Raymond, J. K. (2023). Virtual peer groups reduce HbA1c and increase continuous glucose monitor use in adolescents and young adults with type 1 diabetes. Diabetes Technology & Therapeutics, 25(9), 589–601. https://doi.org/10.1089/dia.2023.0199

Brar, G., Carmody, S., Lumb, A., Shafik, A., Bright, C., & Andrews, R. C. (2024). Practical considerations for continuous glucose monitoring in elite athletes with type 1 diabetes mellitus: A narrative review. The Journal of Physiology, 602(10), 2169–2177. https://doi.org/10.1113/JP285836

Conway, R. B., Snell-Bergeon, J., Honda-Kohmo, K., Peddi, A. K., Isa, S. B., Sulong, S., Sibomana, L., Gerard Gonzalez, A., Song, J., Lomax, K. E., Lo, C.-N., Kim, W., Haynes, A., de Bock, M., Burckhardt, M.-A., Schwab, S., & Hong, K. (2025). Disparities in diabetes technology uptake in youth and young adults with type 1 diabetes: A global perspective. Journal of the Endocrine Society, 9(1), bvae210. https://doi.org/10.1210/jendso/bvae210

Dicks, J. H., McCann, L. J., Tolley, A., Barrell, A., Johnson, L., Kuhn, I., & Ford, J. (2025). Equity of continuous glucose monitoring in children and young people with type 1 diabetes: A systematic review. Pediatric Diabetes, 2025, 8875203. https://doi.org/10.1155/pedi/8875203

Guédet, C., Alexandre-Heymann, L., Yardley, J. E., Messier, V., Boudreau, V., Chahal, T., Dostie, M., Mathieu, M.-E., Brazeau, A.-S., Tagougui, S., & Rabasa-Lhoret, R. (2025). Exploring perceived barriers to physical activity among individuals with type 1 diabetes in the era of new technologies: An analysis from the BETTER registry. Diabetes & Metabolism, 51(5), 101677. https://doi.org/10.1016/j.diabet.2025.101677

Henske, J., Albashaireh, A., Turner, L. V., Beach, G., & Riddell, M. C. (2025). Are regular aerobic exercisers with type 1 diabetes following current physical activity self-management guidelines? Insights from an online survey. Clinical Diabetes, 43(3), 378–387. https://doi.org/10.2337/cd24-0100

Huerta-Uribe, N., Hormazábal-Aguayo, I. A., Izquierdo, M., & García-Hermoso, A. (2023). Youth with type 1 diabetes mellitus are more inactive and sedentary than apparently healthy peers: A systematic review and meta-analysis. Diabetes Research and Clinical Practice, 200, 110697. https://doi.org/10.1016/j.diabres.2023.110697

Jacobs, P. G., Marak, M. C., Calhoun, P., Gal, R. L., Castle, J. R., & Riddell, M. C. (2024). An evaluation of how exercise position statement guidelines are being used in the real world in type 1 diabetes: Findings from the Type 1 Diabetes Exercise Initiative (T1DEXI). Diabetes Research and Clinical Practice, 217, 111874. https://doi.org/10.1016/j.diabres.2024.111874

Lee, M. Y., Ritter, V., Shaw, B., Ferstad, J. O., Johari, R., Scheinker, D., Bishop, F., Desai, M., Maahs, D. M., & Prahalad, P. (2024). Addressing disparities using continuous glucose monitors and remote patient monitoring for youth with type 1 diabetes. Journal of Diabetes Science and Technology. Advance online publication. https://doi.org/10.1177/19322968241305612

Liarakos, A. L., Crabtree, T. S. J., & Wilmot, E. G. (2024). Patient-reported outcomes in studies of diabetes technology: What matters. Diabetes, Obesity and Metabolism, 26(Suppl. 7), 59–73. https://doi.org/10.1111/dom.15858

Lorenzen, J. T., Madsen, K. P., Cleal, B., Joensen, L. E., Nørgaard, K., Pedersen-Bjergaard, U., Schmidt, S., Rytter, K., & Willaing, I. (2024). Associations between use of diabetes technology and diabetes distress: A Danish cross-sectional survey of adults with type 1 diabetes. BMJ Open, 14(3), e080053. https://doi.org/10.1136/bmjopen-2023-080053

Mathias, P., Mahali, L. P., & Agarwal, S. (2022). Targeting technology in underserved adults with type 1 diabetes: Effect of diabetes practice transformations on improving equity in CGM prescribing behaviors. Diabetes Care, 45(10), 2231–2237. https://doi.org/10.2337/dc22-0555

Patel, P. M., Thomas, D., Liu, Z., Aldrich-Renner, S., Clemons, M., & Patel, B. V. (2024). Systematic review of disparities in continuous glucose monitoring and insulin pump utilization in the United States: Key themes and evidentiary gaps. Diabetes, Obesity and Metabolism, 26(10), 4293–4301. https://doi.org/10.1111/dom.15774

Patton, S. R., Bergford, S., Gal, R. L., Calhoun, P., Clements, M. A., Sherr, J. L., & Riddell, M. C. (2025). Fear of hypoglycemia relates to glycemic levels during and after real-world physical activity in adolescents with type 1 diabetes. Diabetic Medicine, 42(4), e15482. https://doi.org/10.1111/dme.15482

Perkins, B. A., Turner, L. V., & Riddell, M. C. (2024). Applying technologies to simplify strategies for exercise in type 1 diabetes. Diabetologia, 67(10), 2045–2058. https://doi.org/10.1007/s00125-024-06229-x

Prahalad, P., Scheinker, D., Desai, M., Ding, V. Y., Bishop, F. K., Lee, M. Y., Ferstad, J., Zaharieva, D. P., Addala, A., Johari, R., Hood, K., & Maahs, D. M. (2024). Equitable implementation of a precision digital health program for glucose management in individuals with newly diagnosed type 1 diabetes. Nature Medicine, 30(7), 2067–2075. https://doi.org/10.1038/s41591-024-02975-y

Riddell, M. C., Gal, R. L., Bergford, S., Patton, S. R., Clements, M. A., Calhoun, P., Beaulieu, L. C., & Sherr, J. L. (2024). The acute effects of real-world physical activity on glycemia in adolescents with type 1 diabetes: The Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) Study. Diabetes Care, 47(1), 132–139. https://doi.org/10.2337/dc23-1548

Rilstone, S., Oliver, N., Godsland, I., Tanushi, B., Thomas, M., & Hill, N. (2024). A randomized controlled trial assessing the impact of continuous glucose monitoring with a predictive hypoglycemia alert function on hypoglycemia in physical activity for people with type 1 diabetes (PACE). Diabetes Technology & Therapeutics, 26(2), 95–102. https://doi.org/10.1089/dia.2023.0376

Seidu, S., Tetteh, J., Kunutsor, S., Choudhary, P., Khunti, K., & Ajjan, R. A. (2025). Prescription distribution and inequities in diabetes care: A comparative analysis of continuous glucose monitoring access by diabetes status, ethnicity and socio-economic factors in England. Diabetic Medicine, 42(11), e70130. https://doi.org/10.1111/dme.70130

Sherr, J. L., Bergford, S., Gal, R. L., Clements, M. A., Patton, S. R., Calhoun, P., Beaulieu, L. C., & Riddell, M. C. (2024a). Exploring factors that influence postexercise glycemia in youth with type 1 diabetes in the real world: The Type 1 Diabetes Exercise Initiative Pediatric (T1DEXIP) Study. Diabetes Care, 47(5), 849–857. https://doi.org/10.2337/dc23-2212

Sherr, J. L., Laffel, L. M., Liu, J., Wolf, W., Bispham, J., Chapman, K. S., Finan, D., Titievsky, L., Liu, T., Hagan, K., Gaglia, J., Chandarana, K., Bergenstal, R., & Pettus, J. (2024b). Severe hypoglycemia and impaired awareness of hypoglycemia persist in people with type 1 diabetes despite use of diabetes technology: Results from a cross-sectional survey. Diabetes Care, 47(6), 941–947. https://doi.org/10.2337/dc23-1765

Speight, J., Choudhary, P., Wilmot, E. G., Hendrieckx, C., Forde, H., Cheung, W. Y., Crabtree, T., Millar, B., Traviss-Turner, G., Hill, A., & Ajjan, R. A. (2023). Impact of glycaemic technologies on quality of life and related outcomes in adults with type 1 diabetes: A narrative review. Diabetic Medicine, 40(1), e14944. https://doi.org/10.1111/dme.14944

Tilden, D. R., French, B., Datye, K. A., & Jaser, S. S. (2024). Disparities in continuous glucose monitor use between children with type 1 diabetes living in urban and rural areas. Diabetes Care, 47(3), 346–352. https://doi.org/10.2337/dc23-1564

Tremblay, E. S., Bernique, A., Garvey, K., & Astley, C. M. (2024). A retrospective cohort study of racial/ethnic and socioeconomic disparities in initiation and meaningful use of continuous glucose monitoring among youth with type 1 diabetes. Journal of Diabetes Science and Technology, 18(5), 1081–1090. https://doi.org/10.1177/19322968231183985

Wallia, A., Agarwal, S., Owen, A. L., Lam, E. L., Davis, K., Bailey, S. C., DeLacey, S. E., Pack, A. P., Espinoza, J., Bright, D., Eggleston, A., Walter, E., & O’Brien, M. J. (2024). Disparities in continuous glucose monitoring among patients receiving care in federally qualified health centers. JAMA Network Open, 7(11), e2445316. https://doi.org/10.1001/jamanetworkopen.2024.45316

Downloads

Published

2026-08-24

How to Cite

Krupski, A., Marusza, M. ., Stielow, V., & Zatyka, A. (2026). CONTINUOUS GLUCOSE MONITORING AS AN INNOVATIVE DIGITAL HEALTH TECHNOLOGY IN TYPE 1 DIABETES: PSYCHOSOCIAL BARRIERS, PHYSICAL ACTIVITY AND EQUITY OF ACCESS. International Journal of Innovative Technologies in Social Science, 2(3(51). https://doi.org/10.31435/ijitss.3(51).2026.5803