Barrier means more work including monitoring more often and making more adjustments.
Changing the perception of hassle is most likely the most common barrier we can deal with for type 1 patients who do not choose to wear pumps and CGM’s.
Findings from a survey of more than 1,500 participants in the T1D Exchange were published online November 29 in Diabetes Care by Molly L. Tanenbaum, PhD, of the department of pediatrics, Stanford University School of Medicine, Palo Alto, California, and colleagues.
In the survey, which includes data for more than 28,000 type 1 diabetes patients at 75 specialty clinics around the United States, about two-thirds were wearing insulin pumps, but in 2013–2014 only about 9% were using CGMs.
Cost is the most common reason for those who don’t have insurance. This was the most often-cited reasons for not wearing insulin pumps or CGMs.
But the study’s main focus was on potentially modifiable barriers for which interventions could be developed to improve uptake. Of those, “hassle” and cosmetic concerns about wearing a device on the body all the time topped the list, and these reasons were most often cited by younger patients.
Having a discussion with your patients about the use of these technologies can help clear the air and provide possible financial assistance.
Since the data shows quite a variety of different barriers and reasons people may have for not using devices, some of which are modifiable, those conversations may give insight into how to address barriers with patients who may be thinking about starting to use a device or who may be thinking about discontinuing.
We should not want to assume that everyone should be on devices or would benefit from them, but we also don’t want to assume that those who’ve said ‘no’ in the past will never be open to trying it out in the future.
1,503 adult T1D Exchange participants (mean age 35 years, diabetes duration 20 years, 90% white, 61% female) participated in the survey, which used the Diabetes Distress Scale, as well as questions pertaining to technology-use attitudes (general and diabetes-specific), barriers to device use, and reasons for discontinuing devices.
Overall, 38% used insulin pumps only, 32% used insulin pumps and CGMs, 25% used multiple daily injections only, and 5% used CGM with injections.
The most commonly reported barriers were cost of supplies (61%), cost of device (57%), and insurance coverage (57%).
The next four were potentially modifiable: “Hassle of wearing devices all of the time” (47%), “Do not like having diabetes devices on my body” (35%), “Do not like how diabetes devices look on my body” (26%), and “nervous that the device might not work” (20%). Certainly when your insulin pump does not work properly or your CGM gives you faulty readings that can cause you to change your insulin dosage, it can cause major problems and even possibly death, which is a huge barrier as there are no electronic products that work 100% of the time. They eventually breakdown or just become defective.
Overall, those reporting more barriers to using devices were younger, had a shorter diabetes duration, higher HbA1c, higher levels of diabetes distress, and more negative attitudes about both technology in general and diabetes-specific technology (all P < .001 except P = .006 for HbA1c).
Insulin-pump use was higher among women than men (73% vs 65%, P = .003), while CGM use didn’t differ. But interestingly, despite their greater use of pumps, women overall reported more barriers to device uptake (P = .004) and more diabetes distress (P < .001) than did men.
So when we looked at those patients who discontinued CGM, there were 249 participants who had discontinued CGM use and 72 who had stopped wearing their insulin pumps. Of those who stopped using CGMs, the most common reasons cited were cost of supplies (35%), being bothered by alarms (32%), perceiving the alarms to be inaccurate (30%), not liking wearing diabetes devices (30%), and believing the CGM took too much time and effort to use (29%).
For those who quit using insulin pumps, the reasons of not liking to wear diabetes devices (46%) and finding them uncomfortable/painful (44%) were the most commonly endorsed reasons, followed by cost of supplies (21%) and not trusting the device (21%).
Study co-author Korey K Hood, PhD, added that the survey didn’t delve into more precise device-related concerns or whether certain features like tubing-free pumps or smartphone app capabilities might change patients’ views, which is unlikely as the cost and hassle would still exist.
“Our next steps are to develop interventions that match specific barriers,” Hood said. “These interventions will be clinic-based and can be rolled out quickly and without disrupting clinic flow. That is our goal.”
- The most commonly reported barriers were cost of supplies (61%), cost of device (57%), and insurance coverage (57%).
- Next is hassle of wearing devices all of the time (47%) and not like having diabetes devices on the body (35%).
- Those reporting more barriers to using devices were younger, had shorter diabetes duration, higher HbA1c, more diabetes distress, and more negative attitudes about technology.
Diabetes Care. Published online November 29, 2016. Abstract