Barriers and Facilitators to Uptake of Continuous Glucose Monitoring for Management of Type 2 Diabetes Mellitus in Youth

Peyyety, Vaishnavi; Zupa, Margaret F.; Hewitt, Brianna; Rodriguez Gonzalez, Adriana; Mani, Iswariya; Prioleau, Temiloluwa; McCurley, Jessica; Lin, Yu Kuei; Vajravelu, Mary Ellen

doi:10.1177/26350106231205030

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…The psychological dimension of stigma has garnered considerable research attention, especially in relation to diabetes, where it correlates with increased symptoms of depression and anxiety [ 42 ]. CGM usage may evoke concerns regarding physical attractiveness, body image, and draw people’s attention to the presence of the device [ 7 , 20 , 43 ].…”

Section: Research Modelmentioning

confidence: 99%

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

Zoccarato,

Manzoni,

Minotti

et al. 2024

BMC Health Serv Res

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Background The escalating prevalence of diabetes, with its multifaceted complications, poses a pressing challenge for healthcare systems globally. In response, the advent of continuous glucose monitoring (CGM) systems, offering technological solutions for daily diabetes management, presents significant opportunities. However, the widespread adoption faces several barriers, linked both to the technological configuration of the devices and to the psychological dimension of patients. Therefore, this study aims to apply and test a theoretical model that investigates the antecedents of the intention to use Continuous Glucose Monitoring systems. Methods The research model was built to unveil the impacts of psychological factors, functional components and rational constructs derived from the Technology Acceptance Model (TAM) on CGM systems sustained adoption. To ensure the comparability of results, we have collected data from people who had used Dexcom ONE Dexcom (San Diego, CA) for the first time for at least one month. Employing Structural Equation Modelling (SEM) techniques, the hypothesized relationships among constructs were assessed. Results The analyses confirmed the positive correlation of rational factors to the Intention to Use. Subjective Norm, intended as the physicians’ influence, is positively correlated with the Perceived Usefulness. Trend Arrows, albeit being negatively correlated with Perceived Usefulness, have a positive correlation on Perceived Ease Of Use, reinforcing its mediating effect towards Perceived Usefulness. Among psychological factors, Trust in the CGM technology positively correlates with Intention to Use. Health Literacy is negatively correlated to the Intention to Use. Conclusions These findings contribute to theoretical and managerial understanding, providing recommendations to enhance the adoption of CGM systems like Dexcom ONE.

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Section: Research Modelmentioning

confidence: 99%

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

Zoccarato,

Manzoni,

Minotti

et al. 2024

BMC Health Serv Res

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Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis

Allaire,

Dennis,

Masturzo

et al. 2024

JMIR Diabetes

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Background: Insurance benefit design influences whether individuals with diabetes who require a continuous glucose monitor (CGM) to provide real-time feedback on their blood glucose levels can obtain the CGM device from either a pharmacy or a durable medical equipment (DME) supplier. The impact of the acquisition channel on device adherence and healthcare costs has not been systematically evaluated.Objective: Retrospective claims analysis compared the adherence rates for patients new to CGM therapy and the costs of care for individuals who obtained CGM devices from a pharmacy versus acquisition through a DME supplier.Methods: Utilizing the Mariner Commercial Claims Database, individuals aged >18 years with documented diabetes and an initial CGM claim during the first quarter of 2021 (2021Q1, index date) were identified. Patients had to maintain uninterrupted enrollment for a duration of 12 months but file no CGM claim during the six months preceding the index date. Propensity score matching was employed to establish comparable Pharmacy and DME cohorts. Outcomes included quarterly adherence, retention, and costs for the period from 2021Q1 to the first quarter of 2022 (2022Q1). Between-cohort differences in adherence rates and retention rates were analyzed using z-tests, and cost differences were analyzed using t-tests.

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Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis (Preprint)

Allaire,

Dennis,

Masturzo

et al. 2024

Preprint

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BACKGROUND Insurance benefit design influences whether individuals with diabetes who require a continuous glucose monitor (CGM) to provide real-time feedback on their blood glucose levels can obtain the CGM device from either a pharmacy or a durable medical equipment (DME) supplier. The impact of the acquisition channel on device adherence and healthcare costs has not been systematically evaluated. OBJECTIVE Retrospective claims analysis compared the adherence rates for patients new to CGM therapy and the costs of care for individuals who obtained CGM devices from a pharmacy versus acquisition through a DME supplier. METHODS Utilizing the Mariner Commercial Claims Database, individuals aged >18 years with documented diabetes and an initial CGM claim during the first quarter of 2021 (2021Q1, index date) were identified. Patients had to maintain uninterrupted enrollment for a duration of 12 months but file no CGM claim during the six months preceding the index date. Propensity score matching was employed to establish comparable Pharmacy and DME cohorts. Outcomes included quarterly adherence, retention, and costs for the period from 2021Q1 to the first quarter of 2022 (2022Q1). Between-cohort differences in adherence rates and retention rates were analyzed using z-tests, and cost differences were analyzed using t-tests. RESULTS Results: Propensity score matching was employed to establish comparable Pharmacy and DME cohorts. A total of 3,716 patients were identified, with 1,858 in the Pharmacy Cohort and 1,858 in the DME Cohort. Although adherence declined over time in both cohorts, the DME Cohort exhibited significantly superior adherence compared to the Pharmacy Cohort at 6 months (Pharmacy 39%; DME 49%; P<0.05), 9 months (Pharmacy 36%; DME 45%; P<0.05), and 12 months (Pharmacy 33%; DME 41%; P<0.05). Mean annual total medical costs for adherent patients in the Pharmacy Cohort were 18% (or $1,336) higher compared to the DME Cohort (Pharmacy $8,716; DME $7,380; P<0.01). In non-adherent patients, the DME Cohort exhibited a significantly higher rate of therapy reinitiation during the period compared to the Pharmacy Cohort (Pharmacy 12.1%; DME 18%; P<0.05). CONCLUSIONS The results from this real-world claims analysis demonstrate that, in a matched set of individuals who received their CGM through a DME supplier or a pharmacy, those whose supplies were provided through the DME channel were more adherent to their device. For individuals who experienced a lapse in therapy, those whose supplies were provided through the DME channel were more likely to resume use after an interruption than those who received their supplies from a pharmacy. In the matched cohort analysis, those who received their CGM equipment through a DME supplier demonstrated a lower total cost of care.

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Barriers and Facilitators to Uptake of Continuous Glucose Monitoring for Management of Type 2 Diabetes Mellitus in Youth

Cited by 3 publications

References 42 publications

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

Unveiling the interplay between rational, psychological and functional factors in continuous glucose monitoring early adoption: Novel evidence from the Dexcom ONE case in Italy

Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis

Exploring the Impact of Device Sourcing on Real-World Adherence and Cost Implications of Continuous Glucose Monitoring in Patients With Diabetes: Retrospective Claims Analysis (Preprint)

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