After ONBOARDing: Examining drivers of CGM discontinuation following a CGM uptake trial - Project Summary Type 1 diabetes (T1D) is a chronic disease with a demanding self-management burden. Few (<25%) adults with T1D meet ADA-recommended targets for glycemic control, thereby increasing long-term complication risk. Diabetes technology (insulin pumps; continuous glucose monitoring, or CGM) alleviates management burden and promotes achievement of treatment goals. CGM systems improve glycemic control, benefitting long-term health outcomes without increasing risk of hypoglycemia. Major improvement in CGM accuracy has led to advances in closed loop systems that integrate an insulin pump and CGM to partially automate insulin delivery, improve glycemic control and reduce T1D management burden. To reap these health benefits, CGM users must wear the device daily. Despite benefits, a concerning proportion of adults who try CGM later discontinue use, but remaining drivers of discontinuation and inconsistent use are unclear. Greater understanding of when and why adults with T1D discontinue CGM after initial adoption is needed to target and tailor well-timed interventions to promote and sustain consistent CGM use. The proposed study complements the parent K23 (DK119470) goal of refining and evaluating a behavioral intervention, ONBOARD, that aims to promote CGM adoption and sustained use through targeting top known modifiable barriers (physical, data, social, and trust) for adults with T1D. Preliminary data from the parent trial show an estimated 24% of CGM adopters discontinuing use. This mixed method study extends the parent K23 by gathering in-depth qualitative data on participants reporting CGM non-use 12-months after initial CGM adoption; and conducting longitudinal analysis on factors linked to reduced CGM use and discontinuation. ONBOARD participants receive 3 months of CGM supplies to enable initial adoption. We collect CGM, A1c, and psychosocial data over 12 months, creating opportunity for systematic investigation of CGM use and discontinuation following uptake. The specific aims in this proposal are to 1) collect in-depth qualitative data on key remaining drivers of CGM discontinuation through user-centered methods, and 2) identify factors associated with lower CGM use and discontinuation in the year following CGM initiation using the full K23 sample. Examining remaining modifiable barriers to durable CGM uptake in adults with T1D will expand the reach of the existing K23 study to optimize timing and content of support for individuals at risk of discontinuing CGM. Completion of the proposed R03 aims will generate critical preliminary data to conduct a large scale R01 study to test a refined ONBOARD intervention to promote uptake and prevent discontinuation of CGM in adults with T1D. Completion of these proposed aims will further Dr. Tanenbaum’s career goal to establish an independent programmatic line of research focused on optimizing diabetes technology use to improve health and quality of life outcomes for adults with T1D.
