medwireNews: A survey of US adolescents with type 1 diabetes has found that cost, negative attitudes towards wearing a device, and technology-related anxiety all act as obstacles preventing the use of devices in this age group.
In an online questionnaire of 411 young people aged 12 to 19 years, cost-related concerns were most commonly cited as a barrier to using insulin pumps or continuous glucose monitors (CGMs), with close to two-thirds (61%) of respondents highlighting this as a reason.
These non-modifiable concerns included the cost of devices (47.0%), the cost of supplies such as infusion sets or CGM sensors (45.7%), and insurance coverage (41.6%).
The most frequently mentioned modifiable barriers were wear-related issues, cited by 58.6% of respondents, including the hassle of wearing a device (37.7%), followed by disliking the device on the body (33.1%), and disliking how the device looked on the body (29.2%).
A fifth (20.0%) of respondents were worried about what others would think of them, while 24.6% were nervous that the device might not work and 20.4% did not want to take more time to manage their diabetes, the researchers add in Diabetes Technology & Therapeutics.
“This study elucidates a number of important clinical intervention targets for adolescents using diabetes devices, and highlights the heightened importance adolescents place on worrying about what others will think of them compared with adults who use devices,” they say.
The cross-sectional survey conducted in 2018 included participants with a mean age of 16.30 years, who had lived with diabetes for a mean of 9.54 years. Just over half were female and more than eight in 10 identified as White and non-Hispanic.
Overall, 74.7% used insulin pumps and 54.7% used CGMs. Glycated hemoglobin levels were only available in 73 (18%) of those surveyed, and the average was 8.6% (70 mmol/mol).
When barriers were separated into five categories, issues relating to cost were highlighted by 60.8%, those relating to wear by 58.6%, anxiety relating to technology by 31.9%, concerns regarding time by 24.1%, and support-related concerns by 6.3%.
Laurel Messer (University of Colorado, Aurora) and team report: “Nearly one-third (31.9%) of the sample endorsed both cost- and wear-related issues, and nearly one-quarter (24.3%) endorsed both anxiety- and wear-related issues.”
Respondents who identified more barriers to using diabetes devices were significantly more likely than others to report more negative attitudes to diabetes technology and lower self-efficacy in diabetes management.
They were also moderately more likely to report diabetes distress, family conflict, and depressive symptoms, the researchers note.
“As diabetes technology continues to evolve, user interaction with diabetes devices will change,” the team proposes. “In the meantime, understanding the adolescent experience with current devices provides meaningful opportunities to reduce barriers, reinforce benefits, and partner with adolescents in the care of their diabetes.”
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