Insulin pumps and continuous glucose monitors (CGM) are increasingly important components of managing type 1 diabetes (T1D) and have been shown to improve glycemic control, health-related quality of life, and treatment satisfaction. [1][2][3][4][5] Device users report benefits such as increased flexibility and freedom and decreased stress.6,7 However, consistent adherence to wearing these devices requires a complex set of user behaviors. Device wearers must change insulin pump and CGM sites frequently; order and maintain the proper supplies and prescriptions; calibrate the CGM through regular blood glucose checks; count carbohydrates; and administer boluses.8,9 Table 1 outlines the numerous adherence tasks required for using insulin pumps and CGM, divided by frequency of engagement in each task.Greater CGM adherence-and engagement in the tasks outlined in Table 1-has been linked to optimal diabetes outcomes. [10][11][12][13][14][15] Specifically, wearing a CGM 6 or more days a week, 15 or at least 60% of the time, 14 has been linked to greater improvements in HbA1c compared to wearing a CGM fewer than 6 days a week. More frequent blood glucose monitoring has been linked to greater CGM adherence and greater benefit from CGM.12 Furthermore, greater adherence to CGM has been linked to better treatment satisfaction; frequent users may focus more on benefits outweighing the hassles while infrequent users focus more on hassles Abstract Background: Insulin pumps and continuous glucose monitors (CGM) can improve glycemic control for individuals with type 1 diabetes (T1D). Device uptake rates continue to show room for improvement, and consistent adherence is needed to achieve better outcomes. Diabetes health care providers have important roles to play in promoting device use and adherence. Methods:We surveyed 209 clinicians who treat people with type 1 diabetes to examine perceptions of barriers to device uptake, attitudes toward diabetes technology, and resources needed for clinicians to improve device uptake. We compared findings with our survey of adults with T1D.Results: Younger clinicians treated more patients using insulin pumps (r = -.26, P < .001) and CGM (r = -.14, P = .02), and had more positive attitudes about diabetes technology (r = -.23, P = .001). The most frequently endorsed modifiable barriers were perceptions that patients dislike having the device on their body (73% pump; 63% CGM), dislike the alarms (61% CGM), and do not understand what to do with device information or features (40% pump; 46% CGM). Clinicians wanted lower cost and better insurance coverage for their patients, and they recommended counseling and education to help address barriers and improve adherence to devices. Conclusion:Clinicians perceive many barriers to their patients initiating and adhering to diabetes devices. Findings highlight opportunities for intervention to improve clinician-patient communication around device barriers to help address them.

A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.

These clinically meaningful personas of device readiness can inform tailored interventions targeting barriers and psychosocial needs to increase device uptake.

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