Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use

• Published in: Journal of diabetes science and technology Vol. 11; no. 3; pp. 484 - 492
• Main Authors: Tanenbaum, Molly L., Adams, Rebecca N., Hanes, Sarah J., Barley, Regan C., Miller, Kellee M., Mulvaney, Shelagh A., Hood, Korey K.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-05-2017
• Subjects: Adult; Diabetes Mellitus, Type 1; Female; Health Knowledge, Attitudes, Practice; Humans; Insulin Infusion Systems - psychology; Insulin Infusion Systems - statistics & numerical data; Male; Middle Aged; Monitoring, Physiologic - methods; Monitoring, Physiologic - psychology; Monitoring, Physiologic - statistics & numerical data; Patient Compliance; Practice Patterns, Physicians' - statistics & numerical data; Special Section: Adherence and Diabetes; Surveys and Questionnaires; type 1 diabetes; continuous glucose monitor; diabetes providers; insulin pump; technology attitudes; device uptake
• ISSN: 1932-2968; 1932-2968; 1932-3107
• DOI: 10.1177/1932296816688010

Background:
Insulin pumps and continuous glucose monitors (CGM) can improve glycemic control for individuals with type 1 diabetes (T1D). Device uptake rates continue to show room for improvement, and consistent adherence is needed to achieve better outcomes. Diabetes health care providers have important roles to play in promoting device use and adherence.
Methods:
We surveyed 209 clinicians who treat people with type 1 diabetes to examine perceptions of barriers to device uptake, attitudes toward diabetes technology, and resources needed for clinicians to improve device uptake. We compared findings with our survey of adults with T1D.
Results:
Younger clinicians treated more patients using insulin pumps (r = –.26, P < .001) and CGM (r = –.14, P = .02), and had more positive attitudes about diabetes technology (r = –.23, P = .001). The most frequently endorsed modifiable barriers were perceptions that patients dislike having the device on their body (73% pump; 63% CGM), dislike the alarms (61% CGM), and do not understand what to do with device information or features (40% pump; 46% CGM). Clinicians wanted lower cost and better insurance coverage for their patients, and they recommended counseling and education to help address barriers and improve adherence to devices.
Conclusion:
Clinicians perceive many barriers to their patients initiating and adhering to diabetes devices. Findings highlight opportunities for intervention to improve clinician-patient communication around device barriers to help address them.