Physical barriers to device use highlighted in type 1 diabetes patients
medwireNews: Physical barriers such as discomfort and appearance can deter patients with type 1 diabetes from using glucose monitors and insulin pumps, show survey results.
In the case of insulin pumps, these barriers even outweighed the issue of cost among 1503 participants of the Type 1 Diabetes Exchange registry. The study participants, being in the USA, did not have access to a universal healthcare system; 57.3% cited insurance coverage as a barrier to device use, with 57.4% mentioning the cost of the device, and 61.3% the cost of supplies.
The study participants selected from 19 possible barriers identified by Korey Hood (Stanford University School of Medicine, Palo Alto, California, USA) and co-researchers. Of the potentially modifiable barriers, the most frequently cited was the hassle of wearing the device (47.3%), followed by dislike of having devices on the body (34.8%), and disliking their appearance on the body (26.0%).
These complaints were particularly frequent among the 72 participants who had formerly used an insulin pump but then stopped, with nearly half citing dislike and/or discomfort of wearing the device. Notably, patients in the younger age groups were more likely than older patients to dislike the look or feel of diabetes devices on the body, leading the researchers to say that “approaches to increase uptake will need to target these key concerns.”
They observe that access and affordability are often assumed to be the main barriers among younger age groups, but this study highlighted “more personal and social reasons for young adults declining or discontinuing device use,” with 12.5% of those who discontinued pump use also complaining that it attracted too many questions.
Patients in the youngest age group (18–25 years) had markedly lower device uptake, especially of continuous glucose monitoring (CGM) devices, than those in older groups, as well as the highest levels of distress on the 28-item Diabetes Distress Scale and the highest glycated hemoglobin levels.
“Given the value of insulin pumps and CGMs for improving glycemic control, it is essential to address these physical barriers to increase device uptake and improve long-term health outcomes,” the team writes in Diabetes Care.
Nearly a third of CGM discontinuers believed the device to be inaccurate, and around one in five discontinuers of both CGMs and pumps claimed they did not trust the devices, with a similar proportion of all participants citing this as a barrier to device use.
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