The Science of Diabetes Self-Management and Care 2025, Vol. 51(6) 559–568 © The Author(s) 2025 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/26350106251378719 journals.sagepub.com/home/tde
Abstract
Purpose: The purpose of this study was to describe the experiences of women with diabetes using continuous glucose monitoring (CGM) during pregnancy.
Methods: A qualitative descriptive design was used. Fourteen perinatal women participated in this study, and data were collected through in-depth interviews conducted between November 2024 and May 2025. Qualitative content analysis was performed using NVivo software.
Results: The participants were ages 31 to 42 years. One participant had pregestational diabetes, and the remaining 13 had gestational diabetes. Five participants received insulin therapy, and others were managed without insulin. Three key themes emerged: (a) navigating self-care for glucose management by integrating wearable CGM, (b) guidance of health care providers for glucose management and fetal well-being, and (c) expected improvements in affordability and usability. The participants appreciated the convenience and real-time feedback provided by CGM. They actively engaged in self-care by utilizing CGM data along with health care provider guidance to maintain target glucose levels. However, concerns regarding costs and utility were commonly expressed.
Conclusions: This study highlights that integrating CGM into self-care, with guidance from health care providers, can positively influence glucose management during pregnancy. Enhancing access to CGM through supportive health care policies may improve maternal outcomes and reduce health disparities, thus aligning with sustainable development goals.
The global prevalence of diabetes has been rising, and the number of women with diabetes during pregnancy, particularly gestational diabetes mellitus (GDM), is also increasing.1,2 Approximately 14% of all pregnancies worldwide are affected by GDM.2 This trend is particularly concerning because it poses significant health risks to mother and child. A systematic review of 20 studies revealed that pregestational diabetes and GDM are associated with increased risks of adverse maternal and neonatal outcomes, including neonatal hypoglycemia, macrosomia, and preeclampsia.3 A US-based study revealed that adverse pregnancy outcomes in women with GDM increased between 2014 and 2020, including higher rates of preeclampsia, gestational hypertension, preterm birth, and neonatal intensive care unit admission.4 Effective blood glucose management in expectant mothers with diabetes is essential for perinatal outcomes.5
Technology integration in diabetes care has led to significant advances, helping individuals achieve treatment goals while improving their quality of life.6-8 Continuous glucose monitoring (CGM) systems enable 24-hour monitoring and are more effective than conventional self-monitoring.9-11 CGM systems are reportedly better at detecting hyperglycemia and hypoglycemia in pregnant women with GDM.11 A systematic review revealed that CGM is more effective in reducing perinatal complications through lower glucose levels while reducing maternal weight gain and birth weight.10 Health authorities recommend CGM during pregnancy, particularly for type 1 diabetes (T1DM); its use for type 2 diabetes (T2DM) and GDM is advised based on individual needs.12-15 Current evidence highlights the positive impact of CGM on glucose management.16,17 Additionally, diabetes care and education specialists play a vital role in advocating for diabetes technology by collaborating with individuals and health care teams, providing person-centered care that enhances health outcomes and quality of life.18
However, CGM benefits depend on the engagement of users and health care provider (HCP) support.19,20 Studies have explored CGM experiences among the general population, older adults, and young adults with T1DM.21,22 Studies have indicated the perceived benefits in blood glucose management among adults with diabetes23,24 and enhanced health behaviors in insulin-taking people with T2DM.25 However, research on the experiences of women using CGM during pregnancy remains limited.
Pregnant women with diabetes experience physiological changes and are at a high risk of complications. Maintaining glucose control through technology benefits maternal and fetal well-being. In November 2024, the national insurance program began covering CGM systems for pregnant women taking insulin in South Korea. Given the importance of maternal health and the role of technology in diabetes care, understanding the experiences of women using CGM is crucial for improving care and support. The purpose of this study was to describe the experiences of women with diabetes who used CGM during pregnancy. The study question was: What are the experiences of women with diabetes who used CGM during pregnancy, including perceived benefits, challenges, and areas for improvement?
A qualitative descriptive design was employed. This approach allows for a clear and straightforward understanding of participants’ perspectives, providing low-inference descriptions.26 This approach is suitable for describing experiences and enabling a rich understanding of CGM use among women during pregnancy.
Fourteen pregnant women with diabetes participated in this study. Participants were recruited through purposive sampling from hospital-affiliated clinics and social media platforms to ensure diverse representation. This approach targeted individuals who met the inclusion criteria and captured a variety of experiences, including first-time mothers and those with previous childbirths and women with and without insulin use during pregnancy. Eligible participants were invited through direct contact and provided with information about the study’s purpose and procedures. The inclusion criteria were as follows: (1) women with diabetes during pregnancy and (2) those who underwent CGM for at least 2 weeks during pregnancy. The exclusion criteria were as follows: (1) women with diabetes who had never used CGM during the latest pregnancy and (2) those unable to communicate in English or Korean. In this study, the continuous glucose monitor used was the FreeStyle Libre system, a sensor-based wearable device that continuously measures glucose levels in the interstitial fluid for up to 14 days and is typically worn on the upper arm.
This study was approved by the appropriate Ethics Review Board (Institutional Review Board No. 2024-09-019-001) and was conducted in compliance with the Declaration of Helsinki. Participants were informed of the aims of the study, procedures, and right to withdraw at any time without consequences. Confidentiality and anonymity were ensured, and all participants provided written informed consent.
Data were collected through 14 in-depth interviews conducted via Zoom (n = 13) and 1 in-person interview (n = 1). Authors with qualitative research experience conducted interviews using a semistructured guide with no other individuals present. The interview questions were adapted from a previous study involving adults with diabetes using CGM systems.23 Each interview was audio-recorded with consent and lasted 50 minutes to 90 minutes. Data were collected from November 9, 2024, to May 14, 2025, until saturation was achieved. Each participant received a gift card worth approximately $30. The interview questions were organized into 3 stages: introductory, main, and concluding (Table 1). Participants were encouraged to express themselves comprehensively and were asked to elaborate when their responses were unclear, with the intended meaning confirmed during or after the interview.
The audio recordings were transcribed verbatim and analyzed using inductive qualitative content analysis, following the 3 steps—preparation, organization, and reporting—outlined by Elo and Kyngäs.27 Briefly, in the preparation phase, transcripts were checked and read repeatedly, and meaningful units (words, phrases, sentences, etc) were identified. During organization, data were open-coded, categorized, and finally synthesized into themes using NVivo software. One researcher conducted the coding, and the others verified the results. The team then conducted a debriefing to refine the findings. The findings are presented according to the Consolidated Criteria for Reporting Qualitative Research guidelines.28
This study ensured trustworthiness by addressing 4 established criteria: credibility, transferability, dependability, and confirmability.29 Credibility was achieved through verbatim transcription and member checking with 2 participants. Transferability was supported by a detailed description of the context of the study. Dependability was ensured using a structured interview guide and systematic NVivo analysis. Confirmability was achieved through the clarification of meaning, researcher reflections, and the inclusion of participant quotations to support interpretations.
The age of the participants ranged from 31 to 42 years. Of the 14 participants, 4 had delivered (2 on maternity leave), and 10 were pregnant (7 primigravida). Regarding gestational age, 5 were >34 weeks, 3 were between 28 and 34 weeks, and 2 were <20 weeks (9 and 14 weeks). One participant had pregestational diabetes, and the remaining 13 had GDM. Five participants received insulin therapy, and others were managed without insulin.
This study identified 3 main themes: (1) navigating self-care for glucose management by integrating wearable CGM, (2) guidance of HCPs for glucose management and fetal well-being, and (3) expected improvements in affordability and usability (Figure 1).
Facing diabetes in pregnancy and concerns about the health. Most participants reported feeling “shocked” or “surprised” when they were diagnosed with diabetes. They wondered, “Why me?” and worried about finger sticks and potential insulin requirements. They expressed concerns about the risk to their babies, including macrosomia, postnatal hypoglycemic shock, diabetes, and childhood obesity. One participant with a family history of diabetes felt guilty about passing on the genetic risk to her baby. Overall, the participants found managing diabetes during pregnancy burdensome.
I thought it would not apply to me because I am slim and exercise a lot. It was assumed that it only affected people who were overweight or had a family history of diabetes.
I was most worried that my baby might be exposed to risks such as abnormal weight gain, a higher chance of developing diabetes, or even hypoglycemic shock after birth.
Benefits of a CGM providing convenient and continuous monitoring. Participants viewed CGM as highly beneficial compared with finger-stick testing. They appreciated its convenience, continuous glucose tracking, and features, such as alarm alerts and trend visualization. They found that CGM was especially helpful in work environments, social situations, and managing insulin doses. The device promoted a sense of accountability and support, as if someone were “watching over” them. Although most felt reduced stress, a few noted increased stress during constant monitoring.
Before, I sometimes did not measure it [at work], especially when I was busy, and mostly did so [finger stick] at home. With CGM, it is good because I can measure it even during work hours.
When I used finger stick at restaurants, I felt conscious about onlookers and was also concerned about hygiene. I no longer have to worry about these.
Modifying lifestyle with CGM. The participants felt vigilant about their eating habits while wearing the CGM system. They noted glucose fluctuations that helped them create personalized guidelines for healthier food choices. One participant stated, “The hospital initially recommended it [CGM] to me as a way to easily track which foods cause glucose spikes and which ones I could eat for better nutrition without glucose issues.” The participants noticed a spike that motivated them to respond quickly.
Participants reported that their lifestyle changes led to fewer spikes and smaller fluctuations in their graphs. Their eating habits changed significantly because they avoided foods that caused spikes and followed the recommended food amounts and intake orders. They felt motivated to exercise after meals, respond quickly when glucose levels increased, or maintain exercise by adjusting the intensity or time or walking briskly to reach the target levels. One participant stated, “If it does not go down as fast as expected, I can increase the intensity by walking while clapping or doing squats.” Other types of participant feedback were as follows:
I used to eat without following a specific order, but I was told to eat vegetables first, protein second, and a small amount of carbohydrate last. So, I am trying hard to stick to that.
I usually have a big appetite, but after getting pregnant, I started gaining a lot of weight even though I wasn’t eating much. Therefore, I have become more mindful. I tried to cut back on things like cake, donuts, and snacks, and made an effort to eat more high-quality protein. I also tried to make sure I always walked after meals.
I am pregnant. So, I cannot do strenuous activities; I just walk. As my pregnancy progresses, I get tired. But when my glucose does not go down as expected, I was able to cheer myself up a little bit to do more.
Empowering self-care through education. Participants valued diabetes and nutrition education, which provided structured learning about food exchange and dietary management. Education helped them accept their diabetes as a manageable condition. Some found a 3:2:2 meal ratio difficult to follow and suggested example menus or direct instructions based on their usual diet. Office workers wanted information on diabetes-friendly lunch options at nearby restaurants and office cafeterias and noted that receiving a book and taking pictures helped them follow the guidelines.
They gave me pictures and charts about food groups, such as how many units of grains and proteins I should consume. It was very helpful.
I liked receiving image files. Thus, I could attach them to my refrigerator, allowing me to view and recall them every morning when I opened it.
The participants actively engaged in social media and searched for information about diabetes and CGM during pregnancy. Some joined ImDang Café, an online community for pregnant women with diabetes. They found that the experiences and dietary tips of other mothers, such as which foods spike glucose or which do not, were particularly helpful. Some participants searched YouTube and followed glucose-lowering exercises. One participant searched whether airport X-ray scanners could damage the CGM device. When reviewing social media, one participant noted:
I searched the internet, blogs, and YouTube videos and found a gestational diabetes café. The real experiences and diets shared in the [online] café were very helpful.
I checked how others ate their meals. Watching photographs of frugal breakfasts—like a slice of bread with a little fruit and salads—helped in showing portion sizes instead of just describing them.
Tailored guidance on glucose management and personal self-care. Participants visited obstetrics and endocrinology clinics to monitor fetal health and glucose management. They found that balancing glucose management with proper fetal nutrition was challenging. One participant with anemia and morning sickness stated, “When I couldn’t eat because of morning sickness, it was helpful to confirm if I was in a low blood glucose state.” Another participant, who monitored her glucose level, stated that the sonogram showed that the baby was smaller than expected for gestational age, and her diet was adjusted after counseling.
Participants felt more engaged when the clinicians used CGM glucose graphs instead of manually logged fingerstick readings. For example, hearing, “Your blood glucose tends to be a little high during the day, so consider slightly increasing the insulin dose and focus on managing this peak” was more helpful to participants than a single reading. Additionally, they felt grateful and reassured when clinicians praised their self-care efforts, saying things like, “You are doing well” and “With a little more effort, you won’t need insulin.” Participants on insulin valued receiving color-coded image files from nurses managing women with diabetes, highlighting hypoglycemic points and dosage adjustment advice through text messages.
Because the data were shared automatically, HCPs reviewed it and provided feedback, sending messages via KakaoTalk (a popular messaging app in Korea) such as, “Your fasting values are like this, so it would be good to increase the dose” or “You can lower the dose by 1 unit.” One participant stated,
It [seeing the graph with the clinician] helped me greatly. I pushed myself harder and exercised more to avoid spikes during the next visit. If I had been on my own, I would probably have thought, “This is good enough,” and would not have made so much effort.”
Hope for broader insurance coverage. Participants expressed concerns about CGM costs and wanted lower prices and expanded government support. They emphasized that despite its role in better glucose management for healthier pregnancies, only women receiving insulin therapy received insurance coverage. Given the low birth rates and the rising number of advanced-age pregnancies, they hoped for extended eligibility for all pregnant women requiring glucose management. They noted that the coverage time after delivery was limited, although breastfeeding and newborn care require increased food intake and make glucose tracking difficult, and that CGM would aid in management during this period.
I knew about it [CGM] before, but couldn’t use it because of the price. I am a little worried about it after my pregnancy ends. Purchasing this on my own would be expensive [once government support ends], which is disappointing.
I initially did not use it because it was expensive. However, I kept forgetting to get blood drawn and did not keep a record because it was burdensome, so I eventually started using it.
Enhancements in features and services. The participants were worried that the CGM device may fall off, feared the needle, and were concerned about errors from bending during insertion. Some reported redness at the site, hiving from the adhesive tape, and discomfort when removing it, owing to the strong adhesive. Some participants experienced it catching on their clothing, whereas some felt cautious when others touched them. Some participants who reported bumping into others in crowds or corners started maintaining distance and preferred smaller designs. Some avoided exposing the device to prevent reactions from others. One participant experienced bleeding while replacing the CGM device on the weekend and found it inconvenient for consultations to be available only on weekdays. Regarding the device placement, one participant noted the following:
I slept on my left side as recommended, but it [the sensor] pressed against me, causing discomfort and preventing deep sleep at first. It would be better if it could be attached to other body parts such as the abdomen, rather than just the arms.
Participants expected improvements in recordings, displays, and options for multiple alarms. They found logging difficult because the application only allows food portions in grams or units instead of familiar options, such as “one bowl of rice.” They suggested viewing fasting and postprandial glucose values in red (abnormal) and blue (normal) on a single screen for a selected period, such as 1 or 7 days, for progress tracking. They suggested options for alarms at various glucose levels rather than a single threshold to support better glucose management.
It would be good to link the memo function with photos. I write what I ate as 1/2, but this is somewhat subjective. So, would it not be better to upload a photo too?
I want to write things like 1/2 a bowl of brown rice, but since there is no function to input in this way, it is not helpful. I decided not to use it.
Participants reported signal interruptions when wearing thick winter clothing and occasional discrepancies between CGM and finger-stick glucose readings. One participant noted that smartphone restrictions at the workplace made it difficult to monitor glucose levels using the CGM app. Although a few participants had to replace malfunctioning devices, most found the readings to be generally reliable over time. As one participant explained,
At first, I didn’t fully trust the device. However, over time, I noticed that the readings matched the finger-stick results. From then on, I relied solely on CGM, without using a finger stick.
In this study, the authors aimed to explore the experiences of women using CGM during pregnancy. Three major themes have emerged. The participants found CGM convenient and beneficial for managing diabetes during pregnancy. They reported lifestyle modifications with the support of the HCPs and the CGM system. Participants also expressed expectations of improvements in CGM costs and usability.
Participants expressed significant concerns about the impact of diabetes on the health of the babies. This is consistent with previous research showing that women diagnosed with GDM often express concerns about fetal health and experience self-blame and fear.30,31 Existing evidence confirms that diabetes mellitus during pregnancy is associated with increased risks of adverse maternal and fetal outcomes, including hypertension, preterm birth, macrosomia, and neonatal hypoglycemia.32-34 These risks highlight the critical importance of effective diabetes selfcare during pregnancy.
The participants found the CGM system to be highly convenient, enabling continuous and flexible glucose monitoring without the need for finger stick. This aligns with studies demonstrating that CGM devices are convenient.23,35 Some patients appreciate convenience when they are busy with work or social activities. These results highlight the potential role of CGM in supporting self-care by reducing barriers, such as finger sticks. Some participants were initially concerned about using an unfamiliar device and experienced stress resulting from frequent glucose monitoring. These findings indicate that HCP support based on the needs of women with diabetes is essential for adapting CGM to self-care. Some participants reported sleep difficulties or discomfort while wearing the CGM device on their left arm. Given the benefits of the left lateral position in late pregnancy for optimal fetal circulation,36 educators should address this in their guidance.
Participants reported that CGM helped them become more conscious of their diets and supported lifestyle modifications, such as walking or avoiding foods that cause spikes. They noted a reduced spiking frequency and narrower fluctuation range after using CGM. A review of 41 studies revealed that women diagnosed with GDM often adopt healthier eating habits.30 Moreover, CGM users had better dietary adherence and glycemic control than those who were monitored independently10,16 and had a lower risk of dysglycemia.17,37 This study, aligned with previous studies, suggests that CGM use during pregnancy may support healthier lifestyle changes and effective glucose management, which can enhance perinatal outcomes.
The participants received information through clinical education and social media platforms. They found that dietary education, sharing experiences, meal photos, and CGM were helpful in identifying foods that were better for glycemic control. One study identified a lack of health education as a barrier to a healthy lifestyle among women with GDM.38 Another study highlighted the benefits of combining nutrition education with CGM instruction.39 Our findings show that guidance from nutritionists and diabetes education provided by nurses support effective self-care. Some participants reported difficulties selecting lunch menus at work, indicating the need for information on working women.
This study demonstrates the widespread use of social media among the participants. One study revealed that health professionals and informal sources, including the Internet, were frequent information sources among pregnant women.40 Participants found sharing CGM data with HCPs beneficial because it enhanced communication, made clinical interactions informative, and enabled insulin adjustment guidance via text messages. This study demonstrated that receiving feedback and encouragement from HCPs positively affected self-care. Additionally, this study supports the notion that CGM benefits users and HCPs by providing tailored feedback and enhancing self-care. Similar to our study, health professionals were key informers among pregnant women.40 Adults with diabetes appreciated HCPs reviewing glucose management based on CGM data.23 The findings indicate that HCPs play a crucial role in supporting glucose management through CGM. Given the demands of pregnancy and diabetes care, an integrated approach that combines prenatal and diabetes care with emotional support is essential for pregnant women with diabetes.
High costs and limited insurance coverage remain significant barriers to care41,42; however, CGM reportedly improves glycemic control and pregnancy outcomes in women with diabetes.10,43 This study confirmed that the participants experienced a burden from CGM device costs. Although national insurance coverage for CGM began for T1DM patients in August 2022, it was extended to pregnant women receiving insulin treatment in November 2024 in Korea, requiring 30% self-payment. Because CGM devices improve pregnancy outcomes in women with pregestational diabetes and GDM regardless of insulin administration,16,44,45 policymakers should expand coverage to enhance access to diabetes technology for pregnant women. National and global collaboration is needed to improve access to CGM devices during pregnancy, along with diabetes advocacy.46 These efforts could improve maternal health and align with sustainable development goals. The participants requested improvements in the device function and service quality, particularly on weekends. For dietary recordings, adding culturally relevant units and capturing meal photos can improve utility. Additional selective functional options have also been suggested. Collaboration between technicians and users from diverse cultures may improve adaptation.
This study had some limitations. It was conducted in a single country with a few participants, all of whom used the FreeStyle Libre system, although the interviews continued until data saturation. However, these findings are limited to specific contexts. This study focused on women’s experiences of CGM use during pregnancy. Future research should explore postpartum experiences and HCPs’ perspectives on managing perinatal diabetes with CGM. Despite these limitations, the findings provide valuable insights into how pregnant women with diabetes manage glucose levels using wearable CGM devices.
This study explored the experiences of women with CGM use during pregnancy and identified 3 key themes. These findings support the integration of CGM into diabetes care in pregnant women to enhance glucose management. CGM may facilitate personalized care and feedback, benefiting women with diabetes and clinicians.
This study showed that HCPs could play a critical role in supporting glucose control and fetal well-being in pregnant women with diabetes. These findings also emphasize the importance of expanding health coverage to reduce the financial burden and promote maternal health. A deeper understanding of lived experiences of women and perspectives of clinicians may facilitate the design of best practices for CGM use during pregnancy.
The authors gratefully acknowledge the cooperation of the study participants.
All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors and are in agreement with the manuscript.
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
The authors received no financial support for the research, authorship, and/or publication of this article.
This study was approved by the Institutional Review Board of Hallym University Kangnam Sacred Heart Hospital (No. 2024-09-019-001).
Written informed consent was obtained from all participants after fully explaining the purpose and procedures of the study.
Hee Sun Kang https://orcid.org/0000-0003-3808-306X
Chun-Ja Kim https://orcid.org/0000-0002-7594-5418
The data sets used or analyzed during the current study are available from the corresponding author on reasonable request.
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From Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea (Dr Kang); Department of Nursing, Hallym University Kangnam Sacred Heart Hospital, Seoul, South Korea (Dr Park); Department of Clinical Nutrition and Dietetics, Konan Women’s University, Kobe, Japan (Dr Kang); College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, South Korea (Dr Kim).
Corresponding Author: Chun-Ja Kim, College of Nursing and Research Institute of Nursing Science, Ajou University, 164 Worldcup-Ro, Yeongtong-Gu, Suwon 16499, Republic of Korea. Email: ckimha@ajou.ac.kr
