Background: Diabetes is increasing rapidly in low- and middle-income countries (LMICs), where optimal glycaemic control is often constrained by episodic capillary glucose testing. Continuous glucose monitoring (CGM) provides continuous glucose data and clinically useful metrics such as time in range. This scoping review synthesised health-system implementation barriers and patient-level adherence challenges affecting CGM use in LMICs.

Methods: Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, five databases (PubMed, Web of Science, Scopus, IEEE Xplore, and CINAHL) were searched for peer-reviewed studies published between 2021 and 2026. Dual data charting was piloted on five studies, and a four-quadrant barrier taxonomy was applied for qualitative synthesis.

Results: Fifteen studies were included. Economic barriers predominated, including a tenfold sensor cost differential (USD 1,055 vs USD 116 for capillary testing), limited public insurance reimbursement, and out-of-pocket costs representing 18–25% of household income. Technical barriers included poor electronic health record integration and sensor adhesion failures in tropical climates. Clinical challenges included severe specialist shortages (~100 endocrinologists nationwide in one setting) and physician clinical inertia. Patient adherence was affected by low digital literacy, social stigma, and alarm fatigue.

Conclusions: Scaling CGM in LMICs requires coordinated strategies addressing affordability, infrastructure, workforce capacity, and patient engagement. Priority approaches include government-supported chronic disease insurance, regional pooled procurement, structured intermittent CGM protocols (14-day monitoring every 3–6 months), electronic health record interoperability, and task-shifting to trained nurse educators. These measures could improve equitable and sustainable access to CGM and strengthen diabetes management in resource-constrained settings.

As a Medical Doctor, Lecturer, and Digital Health Specialist, I have extended my services in the field of healthcare as a healthcare provider for more than a decade. I have medical experience from being an undergraduate at the largest hospital in Sri Lanka to serving in two teaching hospitals in the country. After obtaining my MSc and MD from the Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, I have worked as a Lecturer and a Supervisor. I am a Certified Health Informatician Australasia (CHIA), a member of the Australasian Institute of Digital Health (AIDH), an expert in digital health systems, healthcare interoperability (HL7 FHIR, SNOMED CT, OpenHIE, DHIS2, CRVS), and ethical medical AI. Currently, I’m working as a Commonwealth Digital Health Fellow at the Rosemary Bryant AO Research Centre, Adelaide University, Australia.