Cost, Hassle, and On-Body Experience: Barriers to Diabetes Device Use in Adolescents and Potential Intervention Targets.

BACKGROUND: Adolescents with diabetes have the highest A1cs of all age group. Diabetes devices (insulin pumps and continuous glucose monitors [CGM]) can improve glycemic outcomes, and though uptake of devices have increased, they remain underutilized in this population. This study characterizes adolescent-reported barriers to diabetes device use to determine targets for clinician intervention. METHODS: We surveyed 411 adolescents with type 1 diabetes (mean age 16.302.25 years) on barriers to diabetes device use, technology use attitudes (general and diabetes-specific), benefits and burdens of CGM, self-efficacy for diabetes care, diabetes distress, family conflict, and depression. We characterize barriers to device uptake; assess demographic and psychosocial differences in device users, discontinuers, and non-users; and determine differences in device use by gender and age. RESULTS: The majority of adolescents used an insulin pump (n=307, 75%) and more than half used CGM (n=225, 55%). Cost/insurance-related concerns were the most commonly endorsed barrier category (61%) followed by wear-related issues (58.6%) which includes hassle of wearing the device (38%), and dislike of device on body (33%). Adolescents who endorsed more barriers also reported more diabetes distress (p=0.003), family conflict (p=0.003), and depressive symptoms (p=0.014). Pump and CGM discontinuers both endorsed more barriers and more negative perceptions of technology than current users, but reported no difference from device users in diabetes distress, family conflict, or depression. Gender was not related to perceptions of devices. CONCLUSIONS: Clinicians can proactively assess attitudes toward diabetes technology and perceptions of benefits/burdens to encourage device uptake and potentially prevent device discontinuation among adolescents.