Table 14.

Summary of recommendations, gaps and opportunities: addressing psychological and behavioral issues

Recommendations
AID clinical trials should include participants from diverse populations to ensure equitable access; to improve sustainable engagement in poor areas; to reduce healthcare disparities and make this technology more broadly accessible to underserved areas.
Trials should pivot away from the typical participants of past studies who tend to be quite “tech-savvy” and have already adopted use of devices such as CGM and insulin pumps. Studies of the processes involved in AID adaptation and adoption in these groups will likely reveal an even more urgent need for PwD education and support, as well as programs to address psychosocial barriers to technology use.
Engaging primary care is essential for bringing AID technology as a viable option to the full quorum of PwD to ensure they can consider its use. This will require not only industry support, but also increased education.
Specific support should be available to all clinicians caring for people with diabetes, including the necessary resources to make AID systems viable options in as many clinical settings as possible. This support should also focus on improving workflow and reducing HCP burden.
AID systems must be used to focus on reducing time spent on diabetes self-management, increasing well-being. The avoidance of medicalizing psychosocial outcomes must be emphasized.
Opportunities/Gaps
AID systems can be used to detect daily glucose fluctuations related to psychological stress. Algorithms can be improved accordingly, as user experience is taken into account during algorithm development (126).
Future research should consider the role of AID in PwD with eating disorders and other vulnerable groups.
Further work exploring AID associated improvement for children and families is necessary. Improvement should be quantified and contextualized in terms of potential reduction of risk of intended self-injury and suicidal acts.
Studies evaluating long-term health benefits of AID related to improved glycemia are needed (such as reduction in diabetes-related complications, neurocognitive outcomes, etc).

Abbreviations: AID, automated insulin delivery; CGM, continuous glucose monitoring; PwD, people with diabetes.