Continuous glucose monitoring to improve pregnancy outcomes: a scoping review of the inclusion of persons of colour, minority and indigenous groups in research

Abstract Introduction The burden of type 2 and gestational diabetes in pregnancy is highest amongst those underserved by health systems, including Indigenous peoples, persons of colour, and ethnic minority groups. Continuous glucose monitoring (CGM) is an emerging technology that provides real time analyses of interstitial glycemia. Although the evidence of impact of CGM on glycemia monitoring in pregnancy and neonatal outcomes has been synthesised, the extent to which persons of colour, minority and Indigenous populations have been represented in this evidence base remains unclear. Objectives To describe (1) the extent to which Indigenous and/or not-white minority populations have been included in research of CGM as part of antenatal care for patients with diabetes in pregnancy. (2) The extent to which Indigenous and/or not-white minority populations have been included in research regarding acceptability or experience of CGM use in pregnancy. (3) Any specified methods to reduce barriers to Indigenous and minority people's participation within randomised clinical trials of CGM in management of diabetes in pregnancy. Methods Scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. A systematic search was undertaken across 2 databases, and abstracts and full texts reviewed by two independent reviewers. Data was extracted to summary tables. Findings From 1209 imported references we identified 28 studies assessing use of antenatal CGM on clinical outcomes and 11 studies assessing acceptability or satisfaction of CGM use in pregnancy. Ethnicity was reported in 15/28 studies of clinical outcomes and 3/11 studies addressing acceptability. Across 15 studies that reported ethnicity, there was low representation of persons of colour, ethnic minority, and Indigenous populations. Within randomised studies of antenatal CGM use we did not identify methodology that was described as specifically used to increase participation or retention of minority groups. Conclusion Ethnicity of participants in antenatal CGM research has not been consistently reported. In most studies where ethnicity is reported, there is under representation of persons of colour, ethnic minorities and Indigenous peoples. There exists a scientific, ethical and public health policy imperative to ensure that future research on antenatal CGM is designed to be both accessible and culturally acceptable to Indigenous, persons of colour and ethnic minority groups.