Practical Diabetes Technology: Overcoming Barriers in the Real World

Abstract

T his is the third ATTD yearbook article on practical diabetes technology. This article is versatile in highlighting literature that does not fit squarely into therapyspecific categories. The first year focused on real-world outcomes and use, practical challenges, and economics (1). The second year highlighted articles on access, education, and decision support (2). Even 2 years ago, real-world data on new devices were limited, with few articles broaching the translation of devices from clinical trials to commercial use. Today, personal diabetes technologies such as insulin pumps, continuous glucose monitors, flash glucose monitors, or advanced sensor-augmented pump systems are the new standard of care for many individuals with diabetes. The glycemic benefits to commercial users are now more firmly embedded in extant literature (3-5). The purpose of this article, therefore, is not only to review real-world glycemic outcomes but also to explore individual and macrolevel barriers and facilitators that impact successful use of diabetes devices. This is important because optimal use of diabetes devices is often what leads to improved control. This is where the proverbial rubber meets the road.Articles were reviewed through the lens of addressing real-world concerns: Who is using and who is discontinuing devices? Who is not able to use devices? What are the personal and system-level barriers inhibiting or facilitating device use? We included original research articles retrieved from PubMed dating from July 2019 to June 2020, using search terms related to insulin pump, hybrid closed loop (HCL), continuous glucose monitor (CGM), flash/intermittently scanned CGM (isCGM), real-time CGM (rtCGM), and telemedicine. Important context terms included ''real-world use,'' ' 'barriers,'' ''discontinuation,'' reimbursement,'' ''cost-effectiveness,'' ''practical,'' ''clinical care,'' and ''education.'' Over 700 article titles were reviewed for pertinence and possible inclusion in this article. Thirty-eight articles were selected to be reviewed in-depth, and 10 were selected for discussion in this article.The articles are broken down into the following three themes: (1) benchmarks in the real world, (2) person-level barriers and device discontinuation, and (3) system-level barriers and implications. Barriers are multifaceted conditions that affect both the uptake of device use and the quality of device use, both of which predict glycemic control.

Diabetes technology: A primer highlighting the role of the pharmacist

“…In general, obstacles to successful and sustained use of diabetes technology can be categorized into two broad domains, the individual and the health care system. Individual factors include physical discomfort, perceived burden of wearing and using a device, the ability to trust technology, alarm use, and financial costs while health system factors include provider knowledge and attitudes toward technology 4 . There is also a racial‐ethnic disparity with access to diabetes technology 5 .…”

“…Individual factors include physical discomfort, perceived burden of wearing and using a device, the ability to trust technology, alarm use, and financial costs while health system factors include provider knowledge and attitudes toward technology. 4 There is also a racialethnic disparity with access to diabetes technology. 5 Health care teams members, including pharmacists, can play a major role in reducing these barriers and improve shared decision-making regarding the individualization of technology in diabetes care.…”