Adopters and discontinuers: Mapping the diabetes device adoption journeys of adults with type 1 diabetes after continuous glucose monitoring uptake.

Abstract

Automated insulin delivery (AID) is standard of care for type 1 diabetes (T1D) management and requires using an insulin pump and continuous glucose monitor (CGM). While AID uptake is increasing, barriers remain to adopting and maintaining device use. Little is known about barriers and facilitators of optimal AID adoption and use. We conducted follow-up interviews with adults with T1D who had participated in a CGM uptake study and either a) adopted AID within the first year of CGM uptake or b) discontinued CGM use within the first year of CGM adoption. Semi-structured interviews elicited barriers and facilitators experienced at each phase of the device adoption journey. Interviews were audio-recorded, transcribed, and analyzed using content analysis, and used to map device adoption journeys. Thirty-four participants attended interviews (n = 15 AID users: M age 32.9 ± 6 years, T1D duration 20.5 ± 12 years, 80% female; 67% Non-Hispanic White; and n = 19 CGM discontinuers: M age 34.7 ± 8 years, T1D duration 19.4 ± 10 years, 84% female, 74% Non-Hispanic White). Of CGM discontinuers, 14 had returned to CGM use and 5 were on AID by the time of participation in the follow-up interview. CGM discontinuers' reported barriers included insurance/cost, wearability, and data burden. AID adoption barriers were limited education and counseling for system decision-making and initial adjustment to AID. Participants with access to this support described positive onboarding experiences. AID users reported benefits of AID systems, hurdles encountered during ongoing use, and suggestions for improving onboarding. Support for CGM and AID adoption and ongoing use is not standardized or consistently delivered; participants described heterogeneous pathways to device adoption and levels of support, highlighting opportunities to enhance education, counseling, and ongoing support for AID use along the full adoption journey. Availability of as-needed, ongoing support for AID decision-making, adoption, and use particularly during the initial months will improve and sustain device uptake.