title: Diabetes Device Use in Adults With Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets.
abstract: Diabetes devices (insulin pumps, continuous glucose monitors [CGMs]) are associated with benefits for glycemic control, yet uptake of these devices continues to be low. Some barriers to device uptake may be modifiable through psychosocial intervention, but little is known about which barriers and which patients to target.
  
  
  
  We surveyed 1,503 adult T1D Exchange participants (mean age 35.3 [SD 14.8] years, mean diagnosis duration 20.4 [SD 12.5] years) to investigate barriers to device uptake, understand profiles of device users versus nonusers, and explore differences by age and sex. Scales used were the Diabetes Distress Scale, Technology Use Attitudes (General and Diabetes-Specific), and Barriers to Device Use and Reasons for Discontinuing Devices.
  
  
  
  Most commonly endorsed modifiable barriers were related to the hassle of wearing devices (47%) and disliking devices on one's body (35%). CGM users (37%) were older than nonusers (mean 38.3 vs. 33.5 years), had diabetes for longer (22.9 vs. 18.8 years), had more positive technology attitudes (22.6-26.0 vs. 21.4-24.8), and reported fewer barriers to using diabetes technology than nonusers (3.3 vs. 4.3). The youngest age-group (18-25 years) had the lowest CGM (26% vs. 40-48%) and insulin pump (64% vs. 69-77%) uptake, highest diabetes distress (2.2 vs. 1.8-2.1), and highest HbA1clevels (8.3% [67 mmol/mol] vs. 7.2-7.4% [55-57 mmol/mol]).
  
  
  
  Efforts to increase device use need to target physical barriers to wearing devices. Because young adults had the lowest device uptake rates, highest distress, and highest HbA1ccompared with older age-groups, they should be the focus of future interventions to increase device use.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Molly L
authors.identifier: 0000-0003-4222-4224
authors.initials: ML
authors.lastname: Tanenbaum
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Hanes
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Kellee M
authors.initials: KM
authors.lastname: Miller
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Diana
authors.initials: D
authors.lastname: Naranjo
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bensen
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA kkhood@stanford.edu.
authors.forename: Korey K
authors.initials: KK
authors.lastname: Hood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin