Perceptions of Psychosocial Factors and the Insulin Pump

Abstract

OBJECTIVE -The purpose of this study was to identify psychosocial issues related to diabetes, approaches to self-care, self-perceptions, and social interactions among insulin pump users with type 1 diabetes.RESEARCH DESIGN AND METHODS -Adult insulin pump users participated in focus groups loosely formed on the basis of A1C level. Transcripts of focus group meetings were coded into themes by five reviewers using NVivo2 qualitative software.RESULTS -Thirty adults with long-term diabetes participated in five focus groups: two with low mean ϮSD A1C (6.8 Ϯ 0.4%), one with mid A1C (7.80 Ϯ 0.3%), and two with high A1C (9.1 Ϯ 0.5%). Three major themes were identified: impact on diabetes self-care, emotional reactions to the insulin pump, body image, and social acceptance. Participants who described the pump as a tool to meet glycemic goals also described a more active approach to diabetes and had better glycemic control; those who discussed the pump as a panacea described more passive self-care and had poorer glycemic control. Low A1C groups reported that starting the insulin pump reminded them of feelings they experienced at their initial diabetes diagnosis, whereas the high A1C groups did not report these feelings. Women were more concerned than men about body image and social acceptance with pump use. CONCLUSIONS -Active participation in self-care, realistic expectations of pump use, and emotional recall of diabetes diagnosis were associated with better glycemic control. Interventions to improve diabetes management with pump use should include evaluation and discussion of active versus passive approaches to self-care, recall of diabetes diagnosis, expectations of the pump, and pump-related self-consciousness and body image concerns. The roles of these factors in optimal diabetes management warrant further investigation. Diabetes Care 30:549 -554, 2007

Psychosocial factors associated with use of continuous glucose monitoring

“…The finding on body image concerns is similar to the results of our previous study on the insulin pump, where we found that participants' concerns about the insulin pump affected their body images, with an increased sense of self-consciousness in terms of clothing and public appearance [25]. Subjects in our study further expressed concern about the ways continuous glucose monitoring influenced their public appearance, and this affected their body and self images, particularly in intimate situations.…”

High Reported Treatment Satisfaction in People With Type 1 Diabetes Switching to Latest Generation Insulin Pump Regardless of Previous Therapy

“…In focus group interviews with 30 adults with T1D who were currently using insulin pumps, Ritholz and colleagues identified 4 major themes regarding respondents' reluctance to transition to insulin pump therapy. 8 These included the potential impact on diabetes self-care, emotional reactions to the insulin pump, body image, and social acceptance. Perceived complexity of insulin pumps, particularly among older patients, has also been suggested as a possible deterrent.…”

Influences on Technology Use and Efficacy in Type 1 Diabetes

“…33 Many studies report high levels of satisfaction amongst pump users and their caregivers particularly for the flexibility it confers. [34][35][36][37][38] Pump patients also report a more collaborative relationship with their health care professional (HCP), which in combination with the pump facilitates better diabetes control. 34 However, pumps can create additional work and obligations for families because of the potential to do frequent correction doses and set temporary basal rates.…”

“…Conversely patients with poor control tend to have more negative perceptions about pumps, take a passive approach, adhere poorly to pump selfmanagement tasks, and have unrealistic expectations of IPT leading to discouragement and frustration. 38 Pumps offer flexibility and the potential of a more normal lifestyle, but are a constant reminder of diabetes and could affect body image. Body image concerns are more pronounced in women, who report self-consciousness from wearing their pump and the inevitable questions that arise.…”