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      Facilitators and Barriers to Smart Insulin Pen Use: A Mixed-Method Study of Multidisciplinary Stakeholders From Diabetes Teams in the United States

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          Abstract

          This study sought to identify barriers and facilitators to successful smart insulin pen (SIP) use and gauge prescribing practices and integration into clinical practice by assessing provider and care team perspectives at participating endocrinology clinics within the T1D Exchange Quality Improvement Collaborative. The identified provider-related, patient-related, and clinic- and operational-level barriers and facilitators varied based on clinic knowledge, capacity, and resources. High-impact barriers included insurance coverage and prescribing processes; high-impact facilitators included improved diabetes clinic visit quality and use of SIPs as an alternative to insulin pump therapy. Findings indicated the need for provider and care team education and training on proper SIP features, use, and prescribing.

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          A Tong, P SAINSBURY, J. Craig (2007)
          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Association of numeracy and diabetes control.

            Kerri L Cavanaugh, Alan L Rothman, Ayumi Shintani … (2008)
            The influence of a patient's quantitative skills (numeracy) on the management of diabetes is only partially understood. To examine the association between diabetes-related numeracy and glycemic control and other diabetes measurements. Cross-sectional survey. 2 primary care and 2 diabetes clinics at 3 medical centers. 398 adult patients with type 1 or type 2 diabetes mellitus enrolled between March 2004 and November 2005. Health literacy, general numeracy, and diabetes-related numeracy assessed by using the Rapid Estimate of Adult Literacy in Medicine; the Wide Range Achievement Test, 3rd edition; and the Diabetes Numeracy Test (DNT), respectively. The primary outcome was most recent level of hemoglobin A1c. Additional measurements were diabetes knowledge, perceived self-efficacy of diabetes self-management, and self-management behaviors. The median DNT score was 65% (interquartile range, 42% to 81%). Common errors included misinterpreting glucose meter readings and miscalculating carbohydrate intake and medication dosages. Lower DNT scores were associated with older age, nonwhite race, fewer years of education, lower reported income, lower literacy and general numeracy skills, lower perceived self-efficacy, and selected self-management behaviors. Patients scoring in the lowest DNT quartile (score <42%) had a median hemoglobin A1c level of 7.6% (interquartile range, 6.5% to 9.0%) compared with 7.1% (interquartile range, 6.3% to 8.1%) in those scoring in the highest quartile (P = 0.119 for trend). A regression analysis adjusted for age, sex, race, income, and other factors found a modest association between DNT score and hemoglobin A1c level. Causality cannot be determined in this cross-sectional study, especially with its risk for unmeasured confounding variables. Poor numeracy skills were common in patients with diabetes. Low diabetes-related numeracy skills were associated with worse perceived self-efficacy, fewer self-management behaviors, and possibly poorer glycemic control.
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              Enablers and barriers to effective diabetes self-management: A multi-national investigation

              Mary D. Adu, Usman H. Malabu, Aduli Malau-Aduli … (2019)
              Objective The study aimed to identify the common gaps in skills and self-efficacy for diabetes self-management and explore other factors which serve as enablers of, and barriers to, achieving optimal diabetes self-management. The information gathered could provide health professionals with valuable insights to achieving better health outcomes with self-management education and support for diabetes patients. Methods International online survey and telephone interviews were conducted on adults who have type 1 or type 2 diabetes. The survey inquired about their skills and self-efficacy in diabetes self-management, while the interviews assessed other enablers of, and barriers to, diabetes self-management. Surveys were analysed using descriptive and inferential statistics. Interviews were analysed using inductive thematic analysis. Results Survey participants (N = 217) had type 1 diabetes (38.2%) or type 2 diabetes (61.8%), with a mean age of 44.56 SD 11.51 and were from 4 continents (Europe, Australia, Asia, America). Identified gaps in diabetes self-management skills included the ability to: recognize and manage the impact of stress on diabetes, exercise planning to avoid hypoglycemia and interpreting blood glucose pattern levels. Self-efficacy for healthy coping with stress and adjusting medications or food intake to reach ideal blood glucose levels were minimal. Sixteen participants were interviewed. Common enablers of diabetes self-management included: (i) the will to prevent the development of diabetes complications and (ii) the use of technological devices. Issues regarding: (i) frustration due to dynamic and chronic nature of diabetes (ii) financial constraints (iii) unrealistic expectations and (iv) work and environment-related factors limited patients’ effective self-management of diabetes. Conclusions Educational reinforcement using technological devices such as mobile application has been highlighted as an enabler of diabetes self-management and it could be employed as an intervention to alleviate identified gaps in diabetes self-management. Furthermore, improved approaches that address financial burden, work and environment-related factors as well as diabetes distress are essential for enhancing diabetes self-management.
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                Author and article information

                Contributors
                Osagie Ebekozien:
                ORCID: https://orcid.org/0000-0002-8473-249X
                On behalf of : on behalf of the T1D Exchange Quality Improvement Collaborative
                Journal
                Journal ID (nlm-ta): Clin Diabetes
                Journal ID (iso-abbrev): Clin Diabetes
                Journal ID (publisher-id): clinical diabetes
                Title: Clinical Diabetes : A Publication of the American Diabetes Association
                Publisher: American Diabetes Association
                ISSN (Print): 0891-8929
                ISSN (Electronic): 1945-4953
                Publication date (Print): Winter 2023
                Publication date (Electronic): 15 September 2022
                Publication date PMC-release: 15 September 2022
                Volume: 41
                Issue: 1
                Pages: 56-67
                Affiliations
                [1 ]T1D Exchange, Boston, MA
                [2 ]University of Miami Miller School of Medicine, Miami, FL
                [3 ]Le Bonheur Children’s Hospital, Memphis, TN
                [4 ]University of Washington School of Medicine, Seattle, WA
                [5 ]Stanford Medicine Endocrinology, Stanford, CA
                [6 ]Nationwide Children’s Hospital, Columbus, OH
                [7 ]University of Alabama at Birmingham, Birmingham, AL
                [8 ]University of Mississippi School of Population Health, Jackson, MS
                Author notes
                [*]

                Co-senior author

                Corresponding author: Emma Ospelt, eospelt@ 123456t1dexchange.org
                Author information
                https://orcid.org/0000-0002-4723-001X
                https://orcid.org/0000-0003-0400-7835
                https://orcid.org/0000-0002-3355-0565
                https://orcid.org/0000-0002-8473-249X
                Article
                Publisher ID: CD220068
                DOI: 10.2337/cd22-0068
                PMC ID: 9845084
                PubMed ID: 36714258
                SO-VID: 944c21d3-c9c3-41b2-a4f9-ded3f18e6ca0
                Copyright © © 2022 by the American Diabetes Association
                License:

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at https://diabetesjournals.org/journals/pages/license.

                History
                Page count
                Pages: 12
                Funding
                Funded by: Medtronic Foundation;
                Categories
                Subject: Feature Articles

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