Bias and Barriers: Overcoming Challenges of Automated Insulin Delivery
Key takeaways:
- Automated insulin delivery (AID) systems can help people with diabetes improve their blood glucose and manage insulin delivery with less effort.
- While AID systems offer a lot of benefits, factors like biases, stigma, income, race and ethnicity, and health insurance can be barriers to accessing and successfully working AID into a diabetes management plan.
- Experts recommend that healthcare professionals provide more support for people with diabetes as well as educate themselves on available AID systems and the challenges associated with them.
Automated insulin delivery refers to diabetes technology that uses a continuous glucose monitor (CGM), insulin pump, and smart algorithm to help adjust insulin levels in people with diabetes.
Advances in automated insulin delivery technology, its benefits, and the psychosocial challenges associated with AID systems were at the center of discussion during the ADA 2024 Scientific Sessions in Orlando, Florida.
Benefits of AID systems for people with diabetes
As the name suggests, AID systems help with insulin delivery and usually require less active input and decision-making compared to multiple daily injections.
Some benefits of AID include increased time in range, greater ease of use, and improved glucose management. It can also help people with diabetes better understand how their behaviors might impact their glucose levels.
AID benefits are not just about improved diabetes management. They can also help alleviate some of the mental health burdens of diabetes. Using AID has been shown to:
- Reduce stress, worry, and diabetes distress
- Improve sleep
- Decrease fear of hypoglycemia
- Enhance well-being and quality of life
- Reduce diabetes stigma
In addition, many people with diabetes find that AID systems can help them spend less overall time on their diabetes, reduce the risk of complications, and improve family relationships as they relate to diabetes care.
Challenges around AID system use and health outcomes
Very few studies have explored the burdens reported by people with diabetes using AID systems – and some are surprising.
For example, Jill Weissberg-Benchell, a pediatric psychologist at Lurie Children’s Hospital, explained that even children and teenagers reported concerns about the financial burden of diabetes technology.
“Let that sink in,” she said, emphasizing how deep the impact of some burdens may be.
Other concerns reported include:
- Pain or discomfort from devices
- Mistrust of data
- Hassle and visibility of devices
- Data overload
- More or less conservative management than preferred
- Connectivity challenges
- Alarms and alerts
Each person’s experience is unique. Alarms and alerts, for example, may be a perceived burden due to attracting attention and stigma in public, waking oneself or a partner in the middle of the night, or feeling like a reminder of personal failure in management.
When the perceived burdens of AID systems outweigh the perceived benefits, people may discontinue use or experience diabetes distress, which can negatively impact health outcomes.
How does bias act as a barrier to device use?
While AID systems may not be the best fit for everyone, research suggests that bias from healthcare providers as well as other psychosocial challenges may prevent some people with diabetes from accessing AID and successfully working it into their care routine.
Marisa E. Hilliard, who runs the Resilience And Diabetes Behavioral Research Lab at Baylor College of Medicine, said that of all the barriers for people using diabetes technology, “two-thirds of healthcare providers think that too many alarms are the biggest.”
That said, only 35% of people living with diabetes report this being a main concern. In a survey of healthcare providers who treat people with type 1 diabetes, providers often overestimated the burdens or made assumptions that did not align with the actual experiences of people with diabetes.
How healthcare providers can help improve AID access and use
As Hilliard said, the goal of healthcare providers should be “to help people with diabetes and their families decide on the best option for them right now.” Decisions, she emphasized, should be “based on our conversations with them, not our assumptions.”
Providing more support and understanding of the perspective of each person with diabetes can lead to better outcomes and equip people with the best diabetes care tools possible. Small changes can make a big difference in psychosocial (and diabetes-related) outcomes. Healthcare providers should:
- Make AID an option for everyone. Ask questions, don’t act as a gatekeeper, and never assume who is a good fit.
- Support increased access for individuals facing additional barriers (such as insurance approvals or financial barriers).
- Don’t use stigmatizing language. Diabetes technology can be difficult to discuss, especially when people face unique challenges.
- Understand all device options and keep informed about new ones. Help in setting realistic expectations about what an AID system can do.
- Make sure people with diabetes feel comfortable asking for help when they need it.
- Support each person where they are and check in often. AID might not be the best option now, but it may be later.
“This is really hard,” Weissberg-Benchell said of navigating AID systems for both healthcare providers and their patients. When overcoming the hurdles and psychosocial challenges of diabetes management using AID systems, make space for the perspectives of people with diabetes. How they feel matters.
Learn more about AID systems and the psychosocial aspects of diabetes here: