Diabetes Technology and the Human Factor

Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present an example of human factors research using our data to examine psychological factors associated with technology use. Device/technology uptake and use has increased over the years and at present day is a common clinical practice. There are mixed results in terms of health and psychosocial outcomes, with specific subgroups doing better than others with technology. Our data demonstrated that patients have moderately elevated diabetes distress across differing types of technology used, from low-tech to high-tech options, possibly meaning that technology does not add or take away distress. In addition, users on multiple daily injections compared to all other technology groups have less positive attitudes about technology. Finally, we discuss implications for clinical practice and future research.

Section: Demographic Characteristics Of Technology Usersmentioning

confidence: 99%

Diabetes Technology

Naranjo

Tanenbaum

Iturralde

et al. 2016

“…Modifiable barriers may stem from human factors, including patients' perceptions or beliefs about devices, their attitudes, or their preferences. 24 For example, perceived benefits from devices and ease of use promote CGM adherence. 25,26 Meanwhile, "information overload" and lack of trust are major barriers to using CGM.…”

mentioning

confidence: 99%

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

Tanenbaum

Adams

Hanes

et al. 2017

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.

“…Matching the ergonomic features of a glucose meter with the patient's needs and preferences, may improve both safety and adherence, and also reduce psychological stress. 3,16,17 This study has several limitations. The current questionnaire represents a single point in time and serial questioning would have allowed estimation of the time it took to reach a ceiling level of satisfaction/dissatisfaction.…”

Section: Discussionmentioning

confidence: 96%

How Satisfied Are Patients When Their Choice of Funded Glucose Meter Is Restricted to a Single Brand?

Macdonald

Lunt

Downie

et al. 2017

Background: Many governments and insurers are driving down the cost of medical devices, including glucose meters, by the central management of purchasing decisions. We report patients' responses to an "enforced" change in brand of glucose meter, one year after the introduction of a national sole supplier arrangement for funded glucose meters and strips.Method: Specialist diabetes clinic attendees from two geographical locations completed a questionnaire one year after the final meter changeover date. In the first location, consecutive patients were asked to complete a glucose meter satisfaction questionnaire during their clinic visit. In the second location, this questionnaire was mailed to clinic attendees. Responses to open questions were analyzed thematically. Results:Response rates were 85% and 31% from the first and second locations, respectively and 378 questionnaires were suitable for analysis, 309 from the first and 69 from the second location. Insulin users composed 90% of participants. Results from the two locations were broadly similar. Most participants adapted well to the changeover, however 36% reported ongoing dissatisfaction with their "new" meter. The commonest concern, expressed by 23% of participants, related to meter accuracy and precision.Conclusions: One year after glucose meter changeover, a third of participants expressed dissatisfaction with their meter, with many participants describing a failure to adapt to the sole supplier arrangement. Providing a choice of meters and strips, ideally from two or more brands that have demonstrable differences in technical and ergonomic features, is likely to produce higher overall patient satisfaction than is a sole supplier arrangement.