Diabetes Device Use in Adults With Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets

Abstract

OBJECTIVEDiabetes devices (insulin pumps, continuous glucose monitors [CGMs]) are associated with benefits for glycemic control, yet uptake of these devices continues to be low. Some barriers to device uptake may be modifiable through psychosocial intervention, but little is known about which barriers and which patients to target.RESEARCH DESIGN AND METHODSWe surveyed 1,503 adult T1D Exchange participants (mean age 35.3 [SD 14.8] years, mean diagnosis duration 20.4 [SD 12.5] years) to investigate barriers to device uptake, understand profiles of device users versus nonusers, and explore differences by age and sex. Scales used were the Diabetes Distress Scale, Technology Use Attitudes (General and Diabetes-Specific), and Barriers to Device Use and Reasons for Discontinuing Devices.RESULTSMost commonly endorsed modifiable barriers were related to the hassle of wearing devices (47%) and disliking devices on one’s body (35%). CGM users (37%) were older than nonusers (mean 38.3 vs. 33.5 years), had diabetes for longer (22.9 vs. 18.8 years), had more positive technology attitudes (22.6–26.0 vs. 21.4–24.8), and reported fewer barriers to using diabetes technology than nonusers (3.3 vs. 4.3). The youngest age-group (18–25 years) had the lowest CGM (26% vs. 40–48%) and insulin pump (64% vs. 69–77%) uptake, highest diabetes distress (2.2 vs. 1.8–2.1), and highest HbA1c levels (8.3% [67 mmol/mol] vs. 7.2–7.4% [55–57 mmol/mol]).CONCLUSIONSEfforts to increase device use need to target physical barriers to wearing devices. Because young adults had the lowest device uptake rates, highest distress, and highest HbA1c compared with older age-groups, they should be the focus of future interventions to increase device use.

Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use

“…Literature review, market research, and findings from our T1D adult survey informed the development of this list. 27 Clinicians could select as many barriers as applied. The list included nonmodifiable barriers (eg, costs, insurance) and modifiable barriers (eg, not liking devices on their body, nervous to rely on technology).…”

“…11,27,28 Those who discontinued using insulin pumps cited pain and life interference. 19,27 Finally, individuals endorsing more barriers to device use also report more diabetes distress. 27 Thus, many modifiable barriers may be potential targets for intervention to increase uptake and prevent discontinuation.…”

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

“…Although there are demonstrated glycemic benefits to wearing CGMs for both children [14–16] and adults [16, 17], uptake remains suboptimal primarily due to the burden of wearing the CGM device [11, 18, 19]. Although uptake has increased to 17–25% overall, with more uptake currently in preschool-aged and early school-aged children [1], CGM use is still relatively low given that several systems have been commercially available for almost two decades.…”

“…However, diabetes distress may be a barrier to uptake of diabetes technology. In a recent study examining perceived barriers to CGM and insulin pump use with more than 1000 adults with T1D, those with higher levels of diabetes distress reported more barriers to diabetes technology use and had lower rates of technology use [19]. …”

Continuous Glucose Monitoring and Global Reimbursement: An Update

“…However, rates of insulin pump use among patients with T1DM vary internationally, ranging from <10% in some European countries to up to 38% of patients in select populations in the United States, 30,31 with the majority of patients often treated with multiple daily injections (MDI). Because studies of sensoraugmented pump therapy are unable to determine the independent contributions of the technology components, it is increasingly important to evaluate the contribution of RT-CGM as a standalone intervention in patients receiving MDI, as has been done in several recently published RCTs.…”