Tanenbaum Molly L, Hanes Sarah J, Miller Kellee M, Naranjo Diana, Bensen Rachel, Hood Korey K
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
Jaeb Center for Health Research, Tampa, FL.
Diabetes Care. 2017 Feb;40(2):181-187. doi: 10.2337/dc16-1536. Epub 2016 Nov 29.
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 HbA levels (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 HbA compared with older age-groups, they should be the focus of future interventions to increase device use.
糖尿病设备（胰岛素泵、连续血糖监测仪[CGM]）对血糖控制有益，但这些设备的使用率仍然很低。设备使用的一些障碍可能可通过心理社会干预加以改变，但对于哪些障碍以及针对哪些患者进行干预却知之甚少。
我们对1503名1型糖尿病成人患者（平均年龄35.3岁[标准差14.8]，平均诊断时长20.4年[标准差12.5]）进行了调查，以研究设备使用的障碍，了解设备使用者与非使用者的特征，并探讨年龄和性别的差异。使用的量表包括糖尿病困扰量表、技术使用态度量表（通用和糖尿病专用）以及设备使用障碍和停用设备原因量表。
最常被认可的可改变障碍与佩戴设备的麻烦（47%）以及不喜欢身上佩戴设备（35%）有关。CGM使用者（37%）比非使用者年龄更大（平均38.3岁对33.5岁），患糖尿病时间更长（22.9年对18.8年），对技术的态度更积极（22.6 - 26.0对21.4 - 24.8），并且与非使用者相比，报告的糖尿病技术使用障碍更少（3.3对4.3）。最年轻的年龄组（18 - 25岁）的CGM使用率（26%对40 - 48%）和胰岛素泵使用率（64%对69 - 77%）最低，糖尿病困扰最高（2.2对1.8 - 2.1），糖化血红蛋白水平最高（8.3%[67 mmol/mol]对7.2 - 7.4%[55 - 57 mmol/mol]）。
提高设备使用率的努力需要针对佩戴设备的身体障碍。由于与年龄较大的人群相比，年轻人的设备使用率最低、困扰最高且糖化血红蛋白水平最高，他们应成为未来提高设备使用率干预措施的重点。
