Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado.
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California.
Diabetes Technol Ther. 2020 Oct;22(10):760-767. doi: 10.1089/dia.2019.0509. Epub 2020 Mar 27.
Adolescents with diabetes have the highest A1cs of all age groups. Diabetes devices (insulin pumps and continuous glucose monitors [CGM]) can improve glycemic outcomes, and although the uptake of devices has increased, they remain underutilized in this population. This study characterizes adolescent-reported barriers to diabetes device use to determine targets for clinician intervention. We surveyed 411 adolescents with type 1 diabetes (mean age 16.30 ± 2.25 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 nonusers; and determine differences in device use by gender and age. The majority of adolescents used an insulin pump ( = 307, 75%) and more than half used CGM ( = 225, 55%). Cost/insurance-related concerns were the most commonly endorsed barrier category (61%) followed by wear-related issues (58.6%), which include the hassle of wearing the device (38%) and dislike of device on the body (33%). Adolescents who endorsed more barriers also reported more diabetes distress ( = 0.003), family conflict ( = 0.003), and depressive symptoms ( = 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 the perceptions of devices. Clinicians can proactively assess attitudes toward diabetes technology and perceptions of benefits/burdens to encourage device uptake and potentially prevent device discontinuation among adolescents.
青少年糖尿病患者的 A1c 水平是所有年龄段中最高的。糖尿病设备（胰岛素泵和连续血糖监测仪[CGM]）可以改善血糖控制效果，尽管设备的采用率有所提高，但在该人群中的利用率仍然较低。本研究描述了青少年报告的使用糖尿病设备的障碍，以确定临床医生干预的目标。我们调查了 411 名 1 型糖尿病青少年（平均年龄 16.30±2.25 岁），了解他们在使用糖尿病设备方面的障碍、对技术的使用态度（一般和糖尿病特定）、CGM 的益处和负担、自我效能感、糖尿病困扰、家庭冲突和抑郁。我们描述了设备采用的障碍；评估了设备使用者、停用者和非使用者在人口统计学和心理社会方面的差异；并确定了性别和年龄对设备使用的差异。大多数青少年使用胰岛素泵（ = 307，75%），超过一半使用 CGM（ = 225，55%）。与成本/保险相关的问题是最常被认可的障碍类别（61%），其次是与佩戴相关的问题（58.6%），包括佩戴设备的麻烦（38%）和不喜欢设备在身体上（33%）。报告的障碍越多的青少年也报告了更多的糖尿病困扰（ = 0.003）、家庭冲突（ = 0.003）和抑郁症状（ = 0.014）。泵和 CGM 停用者对技术的态度和对益处/负担的看法都比当前使用者更差，而且在糖尿病困扰、家庭冲突或抑郁方面与设备使用者没有差异。性别与对设备的看法无关。临床医生可以主动评估对糖尿病技术的态度和对益处/负担的看法，以鼓励青少年采用设备，并可能防止设备停用。
