Development of an intervention to target diabetes device use through an identity framework: ACCPTech (Adapt and Commit to CGM and Pump Technology)

Project Summary/Abstract Diabetes technologies to treat type 1 diabetes (T1D) are rapidly advancing: continuous glucose monitors (CGMs) provide data on glucose levels and trends throughout the day without the burden of fingersticks; insulin pumps increase ease of taking insulin without injections; and hybrid closed-loop systems automate insulin delivery by syncing an insulin pump and CGM through a dosing algorithm to allow for reduced user responsibilities. However, despite these advances, use of diabetes technologies remains particularly low in young adults (YAs) with T1D, and many YAs experience suboptimal glucose levels, which places substantial risks upon their long-term health. YAs report the most common reasons for their avoidance or discontinuation of diabetes device use include not liking to wear anything on their body, dislike of how the devices looks on their body, and worries about what others may think. These concerns around personal and social perceptions intersect a major developmental task of young adulthood: identity development. This K23 application, led by Dr. Commissariat, proposes to address the potential challenges of technology use by applying a framework of how YAs “incorporate” T1D into identity (e.g., through stigma management, adjustment to perceived interference, and benefit-finding) in order to design and evaluate a novel intervention to increase uptake and sustained use of diabetes technologies. The 3 aims of the proposed project are to: 1) Explore trends of technology use over time in YAs using electronic health record data; 2) Identify core intervention targets through qualitative analysis of the intersection between technology and identity; and 3) Create, pilot, and evaluate the Adapt and Commit to CGM and Pump Technology (ACCPTech) intervention to enhance diabetes device use in YAs with T1D. The primary outcomes of the ACCPTech pilot RCT are feasibility and acceptability, and preliminary data will contribute to our understanding of how identity relates to device use, and whether addressing identity challenges can enhance device use in YAs. These results will inform a future R01 application of a fully-powered randomized controlled trial to enhance device uptake, use, and subsequent glycemic and psychosocial outcomes in YAs with T1D. The mentorship, education, training, and resources outlined in this proposal will support Dr. Commissariat’s career development and her goal to become a successful, independent behavioral researcher focused on utilizing diabetes identity as a means to improve diabetes-related management and outcomes in children, adolescents, and young adults with T1D.