Implementing continuous glucose monitoring in public primary care for type 2 diabetes management: a convergent mixed-methods study of patient and provider experiences in Singapore.

Abstract

Type 2 diabetes (T2D) is highly prevalent in Singapore, yet glycemic control remains suboptimal in primary care. Continuous glucose monitoring (CGM) offers real-time feedback that may improve self-management, but adoption in Asian primary care settings is limited by cost and system integration challenges. This study evaluated the feasibility, acceptability, and perceived impact of CGM implementation in Singapore's public primary care clinics using a convergent mixed-methods design. A CGM pilot program was conducted across five public polyclinics. We studied a purposive sample of 12 adults with T2D and 10 primary care providers. Patients used CGM sensors for two cycles over a three- to six-month period. Quantitative surveys assessed usability, satisfaction, and perceived outcomes. Semi-structured interviews with patients and providers explored user experiences and implementation barriers. Data were analysed independently and then integrated for a comprehensive assessment. Among the study participants, over 80% of patients found the CGM device easy to use, comfortable, and useful in understanding daily glucose fluctuations. Real-time feedback prompted immediate behaviour changes, 83% reported healthier diets and more frequent glucose monitoring, and 67% felt more confident managing diabetes. Providers unanimously reported that CGM improved clinical decision-making and enhanced patient engagement, enabling more timely and tailored treatment adjustments. Key barriers identified included cost (only 58% of patients were willing to pay out-of-pocket; 89% of providers cited funding concerns), added workload for data interpretation and patient education, and difficulties integrating CGM data into existing workflows. Nonetheless, 67% of patients expressed willingness to reuse CGM if affordable, and providers endorsed its clinical value. CGM use in Singapore's public primary care was feasible and acceptable, supporting individualized diabetes care. Broader adoption will require addressing cost, IT integration, and provider support to realize CGM's full potential in routine T2D management.