Influences on Technology Use and Efficacy in Type 1 Diabetes

Abstract

Since 1921 technology has existed to replace insulin and treat diabetes. Although a definitive link was established between HbA1c and complication risk over 20 years ago, 1 only a minority achieve HbA1c targets despite intensified insulin regimens and new technologies. 2 This narrative review focuses on how psychosocial functioning affects uptake and use of technologies and the impact of technology on psychosocial outcomes in adults and children with type 1 diabetes and their caregivers. It examines evidence from large meta-analyses to small qualitative studies which provide detailed insight into technology use. Self Monitoring of Blood GlucoseFrequent blood glucose testing should be a routine part of diabetes self-care 3,4 as it is integral to intensive insulin therapy 1 and improves glycemic control. 5 However, studies of adult patients reveal low testing frequency, 6,7 which is influenced by psychosocial factors, with increased testing in patients of older age, female gender, longer diabetes duration, on basal bolus therapy compared with less intensive regimens, with decreased hypoglycemic awareness, higher "fear of hypoglycemia" and positive self-care personality traits 6 and less testing in ethnic minorities, smokers, those with low education, 8 low income and language barriers. 7 In adolescents, testing is more frequent in younger age groups, higher social status, and higher self-efficacy and less frequent in those with lower self-esteem, high-stress life events, lower parental support, 9,10 from single parent, lower-income, and ethnic minorities, and when given self-care autonomy before reaching cognitive and social maturity.11 In children, family functioning 12 and parental education 13 predict adherence to diabetes self-management and glycemic control.Qualitative studies in adults show that some perceive selfmonitoring of blood glucose (SMBG) as a tool to achieve good control and a normal life, but others see SMBG as a 639315D STXXX10.1177/1932296816639315Journal of Diabetes Science and TechnologyFranklin AbstractThe majority of people with type 1 diabetes have suboptimal glycemic control, increasing their complication risk. Technology to support diabetes self-care has advanced significantly and includes self-monitoring of blood glucose (SMBG), insulin pump therapy (IPT), continuous glucose monitoring (CGM), and sensor-augmented pump therapy (SAPT), which are stepping stones toward the "artificial pancreas" using closed-loop technology. Use of these technologies improves clinical outcomes for patients with the appropriate skills and motivation. This review addresses the psychosocial factors that influence both technology provision and clinical outcome and also how technology impacts on psychological outcomes. Optimal use of the various diabetes self-management technologies is influenced by previous self-care behaviors, demographic and psychological factors. Provision of IPT is also influenced by the same factors. Despite technology increasing the complexity of treatment, the lack of evidence for adverse...

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A critical review and analysis of ethical issues associated with the artificial pancreas

“…Motivated patients [59, 60] who have a positive outlook on the benefits of the AP with realistic expectations are good candidates for the AP [25, 29], because they will likely persevere when faced with hardships when adapting to the technology. While such patients could be favoured in AP allocation, these attitudes may also be fostered through patient coaching (see below).…”