Since 2000, the diabetes community has witnessed tremendous technological advances that have revolutionized diabetes management. Currently, closed-loop glucose control (CLC) systems, which link continuous subcutaneous insulin infusion and continuous glucose monitoring, are the newest, cutting edge technology aimed at reducing glycemic variability and improving daily management of diabetes. Although advances in knowledge and technology in the treatment of diabetes have improved exponentially, adherence to diabetes regimens remains complex and often difficult to predict. Human factors, such as patient perceptions and behavioral self-regulation, are central to adherence to prescribed regimens, as well as to adoption and utilization of diabetes technology, and they will continue to be crucial as diabetes management evolves. Thus, the aims of this article are three-fold: (1) to review psychological and behavioral factors that have influenced adoption and utilization of past technologies (2) to examine three theoretical frameworks that may help in conceptualizing relevant patient factors in diabetes management, and (3) to propose patient-selection factors that will likely affect future CLC systems.
KovatchevB. Closed loop control for type 1 diabetes. BMJ.2011;342: d1911.
2.
HovorkaRKumareswaranKHarrisJAllenJMElleriDXingDKollmanCNodaleMMurphyHRDungerDBAmielSAHellerSRWilinskaMEEvansML. Overnight closed loop insulin delivery (Artificial Pancreas) in adults with type 1 diabetes: Crossover randomised controlled studies. BMJ.2011;342: 1855.
3.
HovorkaRAllenJMElleriDChassinLJHarrisJXingDKollmanCHovorkaTLarsenAMNodaleMDe PalmaAWilinskaMEAceriniCLDungerDB. Manual closed-loop insulin delivery in children and adolescents with type 1 diabetes: A phase 2 randomised crossover trial. Lancet.2010;375 (9716): 743–51.
4.
ElleriDAceriniCLAllenJMHayesJPesterfieldCWilinskaMEDungerDBHovorkaR. Parental attitudes towards overnight closed-loop glucose control in children with type 1 diabetes. Diabetes Technol Ther.2010;12 (1): 35–9.
5.
Van BonACBrouwerTBvon BasumGHoekstraJBDeVriesJH. Future acceptance of an Artificial Pancreas in adults with type 1 diabetes. Diabetes Technol Ther.2011;13 (7): 731–6.
6.
ChaseHPBeckRWXingDTamborlaneWVCoffeyJFoxLAIvesBKeadyJKollmanCLaffelLRuedyKJ. Continuous glucose monitoring in youth with type 1 diabetes: 12-month follow-up of the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial. Diabetes Technol Ther.2010;12 (7): 507–15.
7.
GargSK. Impact of insulin delivery devices in diabetes care. Diabetes Technol Ther.2010;12Suppl 1: S1–3.
MaahsDMHortonLAChaseHP. The use of insulin pumps in youth with type 1 diabetes. Diabetes Technol Ther.2010;12Suppl 1: S59–65.
10.
RodbardHWBlondeLBraithwaiteSSBrettEMCobinRHHandelsmanYHellmanRJellingerPSJovanovicLGLevyPMechanickJIZangenehF; AACE Diabetes Mellitus Clinical Practice Guidelines Task Force. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus. Endocr Pract.2007;13Suppl 1: 1–68.
11.
PhillipMBattelinoTRodriguezHDanneTKaufmanF; European Society for Paediatric Endocrinology; Lawson Wilkins Pediatric Endocrine Society; International Society for Pediatric and Adolescent Diabetes; American Diabetes Association; European Association for the Study of Diabetes. Use of insulin pump therapy in the paediatric age group: Consensus statement from the European Society for Paediatric Endocrinology, the Lawson Wilkins Pediatric Endocrine Society, and the International Society for Pediatric and Adolescent Diabetes, endorsed by the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care.2007;30 (6): 1653–62.
12.
TsalikianEMaurasNBeckRWTamborlaneWVJanzKFChaseHPWysockiTWeinzimerSABuckinghamBAKollmanCXingDRuedyKJ; Diabetes Research In Children Network Direcnet Study Group. Impact of exercise on overnight glycemic control in children with type 1 diabetes mellitus. J Pediatr.2005;147 (4): 528–34.
13.
GargSKWalkerAJHoffHKD'SouzaAOGottleibPAChaseHP. Glycemic parameters with multiple daily injections using glargine versus insulin pump. Diabetes Technol Ther.2004;6 (1): 9–15.
14.
WuYPGravesMMRobertsMCMitchellAC. Is insulin pump therapy better than injection for adolescents with diabetes?Diabetes Res Clin Pract.2010;89 (2): 121–5.
15.
Weissberg-BenchellJAntisdel-LomaglioJSeshadriR. Insulin pump therapy: A meta-analysis. Diabetes Care.2003;26 (4): 1079–87.
16.
PickupJCSuttonAJ. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: Meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med.2008;25 (7): 765–74.
17.
BabarGSAliOPartonEAHoffmannRGAlemzadehR. Factors associated with adherence to continuous subcutaneous insulin infusion in pediatric diabetes. Diabetes Technol Ther.2009;11 (3): 131–7.
18.
De VriesLGrushkaYLebenthalYShalitinSPhillipM. Factors associated with increased risk of insulin pump discontinuation in pediatric patients with type 1 diabetes. Pediatr Diabetes.2011;12 (5): 506–12.
19.
GuinnTSBaileyGJMecklenburgRS. Factors related to discontinuation of subcutaneous insulin-infusion therapy. Diabetes Care.1988;11 (1): 46–51.
20.
RonsinOJannot-LamotteMFVaguePLassman-VagueV. Factors related to CSII compliance. Diabetes Metab.2005;31 (1): 90–5.
21.
The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med.1993;329 (14): 977–86.
22.
StephensEAHeffnerJ. Evaluating older patients with diabetes for insulin pump therapy. Diabetes Technol Ther.2010;12Suppl 1: S91–7.
23.
JornsayDLDucklesAEHankinsonJ P. Psychological considerations for patient selection and adjustment to insulin pump therapy. Diabetes Educ.1988;14 (4): 291–6.
American Association of Diabetes Educators. AADE Position Statement: Continuous subcutaneous insulin therapy using a pump. Diabetes Educ.2009.
26.
CortinaSRepaskeDRHoodKK. Sociodemographic and psychological factors associated with continuous subcutaneous insulin infusion in adolescents with type 1 diabetes. Pediatr Diabetes.2010;11 (5): 337–44.
27.
O'ConnellMACameronFJ. Practical experience with continuous subcutaneous insulin infusion therapy in a pediatric diabetes clinic. J Diabetes Sci Technol.2008;2 (1): 91–7.
28.
EugsterEAFrancisG, Lawson-Wilkins Drug and Therapeutics Committee. Position statement: Continuous subcutaneous insulin infusion in very young children with type 1 diabetes. Pediatr.2006;118 (4): e1244–9.
29.
LenhardMJGraftonDReevesMD. Continuous subcutaneous insulin infusion. A comprehensive review of insulin pump therapy. Arch Intern Med.2001;161 (19): 2293–300.
30.
WysockiTHarrisMAWilkinsonKSadlerMMaurasNWhiteNH. Self-management competence as a predictor of outcomes of intensive therapy or usual care in youth with type 1 diabetes. Diabetes Care.2003;26 (7): 2043–7.
31.
CogenFRStreisandRSarinS. Selecting children and adolescents for insulin pump therapy: Medical and behavioral considerations. Diabetes Spectr.2002;15 (2): 72–5.
32.
PhamM. Diabetes: Updated survey on insulin pumps and continuous glucose monitoring. New York, NY: HSBC Securities (USA) Inc; 2006 Aug.
33.
PhamMPhungV. Diabetes: Updated survey on insulin pumps and continuous glucose monitoring. New York, NY: HSBC Securities (USA) Inc; 2007 Jul.
34.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Beck RW, Buckingham B, Miller K, Wolpert H, Xing D, Block JM, Chase HP, Hirsch I, Kollman C, Laffel L, Lawrence JM, Milaszewski K, Ruedy KJ, Tamborlane WV. Factors predictive of use and of benefit from continuous glucose monitoring in type 1 diabetes. Diabetes Care.2009;32 (11): 1947–53.
35.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment: Evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring (JDRF-CGM) trial. Diabetes Care.2010;33 (1): 17–22.
36.
DeissDBolinderJRivelineJ PBattelinoTBosiETubiana-RufiNKerrDPhillipM. Improved glycemic control in poorly controlled patients with type 1 diabetes using real-time continuous glucose monitoring. Diabetes Care.2006;29 (12): 2730–2.
37.
GargSKZisserHSchwartzSBaileyTKaplanREllisSJovanovicL. Improvement in glycemic excursions with transcutaneous, real-time continuous glucose sensor: A randomized controlled trial. Diabetes Care.2006;29 (1): 44–50.
38.
PickupJCFreemanSCSuttonAJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: Meta-analysis of randomized controlled trials using individual patient data. BMJ.2011;343: d3805.
39.
Diabetes Research in Children Network (DirecNet) Study Group. Psychological aspects of continuous glucose monitoring in pediatric type 1 diabetes. Pediatr Diabetes.2006;7 (1): 32–8.
40.
KashmerLClarkeWGurkaMElchuriSNyerMGonder-FrederickL. Predictors of parental interest in continuous glucose monitoring for children with type 1 diabetes. Diabetes Technol Ther.2009;11 (6): 373–8.
41.
RitholzM. Is continuous glucose monitoring for everyone? Consideration of psychosocial factors. Diabetes Spectr.2008;21 (4): 287–9.
42.
BlockJMBuckinghamB: Use of real-time continuous glucose monitoring technology in children and adolescents. Diabetes Spectr.2008;21 (2): 84–90.
43.
Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, Tamborlane WV, Beck RW, Bode BW, Buckingham B, Chase HP, Clemons R, Fiallo-Scharer R, Fox LA, Gilliam LK, Hirsch IB, Huang ES, Kollman C, Kowalski AJ, Laffel L, Lawrence JM, Lee J, Mauras N, O'Grady M, Ruedy KJ, Tansey M, Tsalikian E, Weinzimer S, Wilson DM, Wolpert H, Wysocki T, Xing D. Continuous glucose monitoring and intensive treatment of type 1 diabetes. N Engl J Med.2008;359 (14): 1464–76.
44.
RitholzMDAtakov-CastilloABesteMBeverlyEALeightonAWeingerKWolpertH. Psychosocial factors associated with use of continuous glucose monitoring. Diabet Med.2010;27 (9): 1060–5.
45.
ChaseHPMesserL. Understanding insulin pumps and continuous glucose monitors. 2nd ed.Denver, CO: Children's Diabetes Foundation; 2010. p. 93–6.
46.
HirschIB. Clinical review: Realistic expectations and practical use of continuous glucose monitoring for the endocrinologist. J Clin Endocrinol Metab.2009;94 (7): 2232–8.
47.
WeinzimerSXingDTanseyMFiallo-ScharerRMaurasNWysockiTBeckRTamborlaneWRuedyK; Diabetes Research in Children Network (DirecNet) Study Group. Freestyle Navigator continuous glucose monitoring system use in children with type 1 diabetes using glargine-based multiple daily dose regimens: Results of a pilot trial. Diabetes Care.2008;31 (3): 525–7.
48.
EvertATrenceDCattonSHuynhP. Continuous glucose monitoring technology for personal use: An educational program that educates and supports the patient. Diabetes Educ.2009;35 (4): 565–7, 571–3, 577–80.
49.
FabiatoKBuseJDuclosMLargayJIzlarCO'ConnellTStallingsJDunganK. Clinical experience with continuous glucose monitoring in adults. Diabetes Technol Ther.2009;11Suppl 1: S93–S103.
50.
WadwaRPFiallo-ScharerRVanderwelBMesserLHCobryEChaseHP. Continuous glucose monitoring in youth with type 1 diabetes. Diabetes Technol Ther.2009;11Suppl 1: S83–91.
51.
ScaramuzzaAEIafuscoDRabboneIBonfantiRLombardoFSchiaffiniRBuonoPToniSCherubiniVZuccottiGV; Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. Use of integrated real-time continuous glucose monitoring/insulin pump system in children and adolescents with type 1 diabetes: A 3-year follow-up study. Diabetes Technol Ther.2011;13 (2): 99–103.
52.
FisherLKHalvorsonM. Future developments in insulin pump therapy: Progression from continuous subcutaneous insulin infusion to a sensor-pump system. Diabetes Educ.2006;32 (1 Suppl): 47S–52S.
53.
KordonouriOPankowskaERamiBKapellenTCoutantRHartmannRLangeKKnipMDanneT. Sensor-augmented pump therapy from the diagnosis of childhood type 1 diabetes: Results of the Paediatric Onset Study (ONSET) after 12 months of treatment. Diabetologia.2010;53 (12): 2487–95.
54.
CongetIBattelinoTGiménezMGoughHCastañedaJBolinderJ; SWITCH Study Group. The SWITCH study (sensing with insulin pump therapy to control HbA(1c)): Design and methods of a randomized controlled crossover trial on sensor-augmented insulin pump efficacy in type 1 diabetes suboptimally controlled with pump therapy. Diabetes Technol Ther.2011;13 (1): 49–54.
55.
PeyrotMRubinRR. Patient-reported outcomes for an integrated real-time continuous glucose monitoring/insulin pump system. Diabetes Technol Ther.2009;11 (1): 57–62.
56.
HalvorsonMCapenterSKaisermanKKaufmanFR. A pilot trial in pediatrics with the sensor-augmented pump: Combining real-time continuous glucose monitoring with the insulin pump. J Pediatr.2007;150 (1): 103–105.e1.
57.
GargSKVoelmleMKBeatsonCRMillerHACrewLBFresonBGHazenfieldRM. Use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injections versus continuous subcutaneous insulin infusion therapy: A prospective 6-month study. Diabetes Care.2011;34 (3): 574–9.
58.
BergenstalRMTamborlaneWVAhmannABuseJBDaileyGDavisSNJoyceCPeoplesTPerkinsBAWelshJBWilliSMWoodMA; STAR 3 Study Group. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med.2010;363 (4): 311–20.
59.
HirschIBAbelsethJBodeBWFischerJSKaufmanFRMastrototaroJParkinCGWolpertHABuckinghamBA. Sensor-augmented insulin pump therapy: Results of the first randomized treat-to-target study. Diabetes Technol Ther.2008;10 (5): 377–83.
60.
RubinRBorgmanSKSulikBT. Crossing the technology divide: Practical strategies for transitioning patients from multiple daily insulin injections to sensor-augmented pump therapy. Diabetes Educ.2011;37Suppl 1: 5S–18S; quiz 19S-20S.
61.
ReachG. Can technology improve adherence to long-term therapies?J Diabetes Sci Technol.2009;3 (3): 492–9.
62.
JanzNKBeckerMH. The Health Belief Model: A decade later. Health Educ Q.1984;11 (1): 1–47.
63.
AjzenI. The theory of planned behavior. Organ Behav Hum Decis Process.1991;50 (2): 179–211.
64.
RogersEM. Diffusion of innovations. 4th ed.New York: The Free Press; 1995.
65.
ReachG. Role of habit in adherence to medical treatment. Diabet Med.2005;22 (4): 415–20.
66.
RosenstockIMStrecherVJBeckerMH. Social learning theory and the Health Belief Model. Health Educ Q.1988;15 (2): 175–83.
67.
Gonder-FrederickLSchmidtKMVajdaKAGreearMLSinghHShepardJACoxDJ. Psychometric properties of the hypoglycemia fear survey-ii for adults with type 1 diabetes mellitus. Diabetes Care.2011;34 (4): 801–6.
68.
HoodKKButlerDAVolkeningLKAndersonBJLaffelLM. The Blood Glucose Monitoring Communication questionnaire: An instrument to measure affect specific to blood glucose monitoring. Diabetes Care.2004;27 (11): 2610–5.
69.
SharifiradGHazavehiMMBaghianimoghadamMHMohebiS. The effect of a Health Belief Model based education program for foot care in diabetic patients type II in Kermanshah, Iran (2005). Int J Endocrinol Metab.2007;5 (2): 82–90.
70.
BondGGAikenLSSomervilleSC. The health belief model and adolescents with insulin-dependent diabetes mellitus. Health Psychol.1992;11 (3): 190–8.
71.
CerkoneyKAHartLK. The relationship between the health belief model and compliance of persons with diabetes mellitus. Diabetes Care.1980;3 (5): 594–8.
72.
WdowikMJKendallPAHarrisMAAuldG. Expanded health belief model predicts diabetes self-management in college students. J Nutr Educ.2001;22 (1): 17–23.
73.
GillibrandRStevensonJ. The extended health belief model applied to the experience of diabetes in young people. J Health Psychol.2006;11 (Pt 1): 155–69.
74.
OmondiDOWalingoMKMbagayaGMOthuonLOA. Understanding physical activity behavior of type 2 diabetics using the theory of planned behavior and structural equation modeling. Int J Hum Social Sci.2010;5 (3): 160–7.
75.
RogersEM. A prospective and retrospective look at the diffusion model. J Health Commun.2004;9Suppl 1: 13–9.
