Perspectives on Diabetes Care

Addressing Psychological Barriers to Insulin Pump Therapy

May 25, 2020, 08:03 AM

by Mark Heyman, PhD, CDCES 

According to data published in Diabetes Care (2018), ONLY 25% of people with type 1 diabetes (T1D) in the United States are using an insulin pump.

Let that sink in for a minute.

Insulin pump therapy is the gold standard treatment for T1D and the vast majority of people with T1D are NOT using a pump.

What are we doing wrong?

Aside from cost, research shows the biggest barriers to using an insulin pump are psychological. For many people, the psychological costs of using an insulin pump simply outweigh any potential benefit.

I am on the front lines here. As a psychologist and certified diabetes care and education specialist (CDCES) who specializes in treating people with T1D, I have a unique window into reasons people do not use insulin pumps – and often there is more to the story than meets the eye. Let me give you an inside look into what is really keeping people from using insulin pumps.

• Wearability: Using an insulin pump means having a device attached to your body all the time. People worry that having something attached to them will be uncomfortable and will draw unwanted attention from others. However that’s not the whole story. T1D is an invisible disease and they see a pump as a physical reminder they have diabetes, something that many people would rather not think about.
• Control: The newest insulin pumps use an algorithm to adjust insulin doses based on blood sugar readings. Some people worry that using an insulin pump means they will be giving away control over their diabetes management. They feel T1D has taken control away in many other parts of their lives, so they are reluctant let go of control over their insulin delivery.
• Burden: Managing T1D is hard work and takes time and energy. Insulin pumps can reduce the burden of diabetes, but some people worry using a pump will do the exact opposite. They worry that a pump will come with a steep learning curve along and additional hassels like alarms, site changes and supply orders, which will increase the burden of diabetes.
• Lack of flexibility: Diabetes can make people feel stuck, and some worry that using a pump will limit what they can do. People with T1D want flexibility in how they manage diabetes and they see a pump as too big of a commitment. They worry they’ll be ‘stuck with it’ and cannot go back on injections if they want a change of pace in how they manage their diabetes.

We must do better! We can do better!

Diabetes care and education specialists (DCESs) can expand access to pump therapy by tackling these barriers head-on. Let’s talk about what DCESs can do to help people with T1D overcome the psychological barriers to using an insulin pump.

1. Acknowledge the barriers: Using an insulin pump can be life-changing; however, the decision to get started is not always an easy one. DCESs can help people who are hesitant about adopting new technology feel heard and validated by acknowledging the psychological challenges to using a pump.

   Specifically, DCESs can:

   • Validate patients’ concerns about pump therapy.
   • Talk openly about the psychological barriers to pump therapy with patients.
   • Check-in with patients after they start using a pump to see if they are experiencing any challenges.
      
2. Offer peer support: People with T1D are influenced by their peers when it comes to using technology. For people experiencing psychological barriers to pump therapy, hearing from others who experienced similar concerns and are now successfully using an insulin pump can be a game-changer. DCESs can take advantage of the power of peer support and facilitate these connections.

   Specifically, DCESs can:

   • Work with insulin pump sales reps to connect patients to current pumper who had similar concerns.
   • Connect patients with online peer support resources such as Beyond Type 1 and TuDiabetes.
   • Refer patient to in-person peer support in your local community.
      
3. Provide support to patients: Living with T1D is challenging. DCESs can support clients in navigating the psychological challenges of living with T1D and using a pump. Simply knowing this support is available may be just what some people need to get them to try an insulin pump and set up them up for success.

   Specifically, DCESs can support clients by:

   • Letting them know you are available to support them in learning how to use the pump.
   • Checking-in regularly with clients around their psycholgocial well-being.
   • Normalizing the psychological challenges of living with T1D.
   • Providing referrals to mental health treatment when appropriate.
      

We will do better!

People with T1D want ways to make living with and managing diabetes easier. By actively addressing the psychological barriers to pump therapy, DCES have an incredible opportunity to open the door to this life-changing technology and make life with diabetes easier for many more people.

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About the Author

Mark Heyman is a diabetes psychologist, Certified Diabetes Care and Education Specialist and the Director of the Center for Diabetes and Mental Health (CDMH). Mark provides education and evidence-based clinical treatment to people with diabetes, cutting-edge training to health care providers, and innovative program development and strategic consulting services to the diabetes business community. Mark received his PhD in Clinical Psychology from The George Washington University and completed his psychology internship at the UCSD School of Medicine. He holds an appointment as an Assistant Clinical Professor in the Department of Psychiatry at UCSD.    

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ADCES Perspectives on Diabetes Care

The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.

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