Barriers to the Adoption of Diabetes Technologies and the Implementation of Connected Insulin Pens in a Largely Minority Population With Type 1 Diabetes.

OBJECTIVE

To assess barriers to diabetes technology adoption in a predominantly minority adult population with type 1 diabetes and to inform a quality improvement strategy to increase use.

RESEARCH DESIGN AND

METHODS

An anonymous survey was distributed to 284 adults with type 1 diabetes at the University of Miami clinic. The Plan-Do-Study-Act framework was used to increase adoption of connected insulin pens among adults using multiple daily insulin injections with continuous glucose monitoring.

RESULTS

Hemoglobin A1c levels were lower in White non-Hispanic adults compared with Black adults (7.1 ± 1.0% vs. 7.8 ± 1.2%; P = 0.033) but did not differ between White non-Hispanic and White Hispanic adults. Technology use was similar across groups. Hemoglobin A1c was lower among those using insulin pump therapy with continuous glucose monitoring than among those using multiple daily insulin injections with continuous glucose monitoring (7.1 ± 0.9% vs. 7.6 ± 1.4%; P = 0.027). Compared with pump users with continuous glucose monitoring, adults using injections with continuous glucose monitoring reported more barriers overall (28.3% vs. 22.1%; P < 0.001), including nervousness about relying on technology (P = 0.010), difficulty interpreting device information (P = 0.041), and limited family support among White Hispanic adults (P = 0.032). After a multicomponent intervention, use of connected insulin pens in addition to continuous glucose monitoring increased from 18% to 27%.

CONCLUSIONS

Increasing adoption of diabetes technology among minority adults with type 1 diabetes remains necessary, even where continuous glucose monitoring use is high.