Tanenbaum Molly L, Adams Rebecca N, Hanes Sarah J, Barley Regan C, Miller Kellee M, Mulvaney Shelagh A, Hood Korey K
1 Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
2 Jaeb Center for Health Research, Tampa, FL, USA.
J Diabetes Sci Technol. 2017 May;11(3):484-492. doi: 10.1177/1932296816688010. Epub 2017 Jan 10.
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.
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.
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.
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.
胰岛素泵和持续葡萄糖监测仪（CGM）可改善1型糖尿病（T1D）患者的血糖控制。设备使用率仍有提升空间，且需要持续坚持使用才能取得更好的效果。糖尿病医疗服务提供者在促进设备使用和坚持使用方面发挥着重要作用。
我们对209名治疗1型糖尿病患者的临床医生进行了调查，以了解他们对设备使用障碍的看法、对糖尿病技术的态度以及临床医生提高设备使用率所需的资源。我们将调查结果与我们对成年T1D患者的调查结果进行了比较。
年轻的临床医生使用胰岛素泵（r = -0.26，P < 0.001）和CGM（r = -0.14，P = 0.02）治疗的患者更多，并且对糖尿病技术的态度更积极（r = -0.23，P = 0.001）。最常被认可的可改变障碍是认为患者不喜欢身上佩戴设备（胰岛素泵为73%；CGM为63%）、不喜欢警报声（CGM为61%）以及不明白如何处理设备信息或功能（胰岛素泵为40%；CGM为46%）。临床医生希望为患者降低成本并提供更好的保险覆盖范围，他们建议进行咨询和教育，以帮助解决障碍并提高对设备的依从性。
临床医生认为患者在启动和坚持使用糖尿病设备方面存在许多障碍。研究结果突出了进行干预的机会，以改善围绕设备障碍的医患沟通，从而帮助解决这些障碍。
