Barriers to continuous glucose monitoring in people with type 1 diabetes: clinician perspectives
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INTRODUCTION: Type 1 diabetes (T1D) is a lifelong disease that requires regular injection of insulin and blood glucose (BG) monitoring. Many diabetes technologies have been created to assist in the management of T1D, including insulin pumps and Continuous Glucose Monitoring (CGM). These systems have been shown to decrease treatment distress and improve glycemic control. However, the uptake of these systems is low due to both cost and other barriers such as discomfort of wear or psychosocial aspects. METHODS: A survey was administered to clinicians of people with diabetes to better understand their perception of patient related barriers to device use. This analysis compares two clusters of clinicians, named "Cautious" and "Ready" based on their readiness to promote CGM use in their patients. Both have positive attitudes towards technology, but the Cautious cluster perceives much higher barriers to device use in their patients than the Ready cluster. In this analysis, the individual barriers, prerequisites to CGM use, confidence in addressing barriers, and clinic staff resources are compared between clusters using independent means t-tests and Pearson chi-square analyses. RESULTS: Results indicate that the confidence in addressing the clinician-reported number 1 rated barrier to CGM use was significantly lower in the Cautious cluster. Also, most individual barriers were perceived significantly more heavily by clinicians in the Cautious cluster. No significant difference was found in prerequisites to CGM use or clinic staff resources between the clusters. DISCUSSION: Because no differences were found in clinician reported prerequisites to CGM use between clusters, it does not seem that the clinicians in the Cautious cluster expect more from their patients before using this technology. One possible explanation would be a clinical deficiency. However, since there was no difference in clinic staff resources, it is unlikely that the availability of these resources contributes to the increased perceived barriers. Thus, the problem may lie in the clinician themselves. One possible explanation for the increased perceived barriers by the Cautious cluster is their lack of confidence in addressing barriers. Our results show that the Cautious cluster is significantly less confident in addressing the #1 barrier their patients face to CGM use, which is most commonly listed as cost-related barriers such as cost of the device or insurance status. One possible solution to this lack of confidence in clinicians is increased education on ways to address and coach patients on cost-related barriers.
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