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.
