O-53: Beyond automated insulin delivery (AID) algorithms: a mixed methods study exploring adolescent perspectives on behavioral, family, and psychosocial factors shaping glycemia
J Hooven-Davis, S Orris, I Libman, C MarchAbstract
Introduction
Many adolescents with type 1 diabetes do not meet recommended glycemic targets despite using AID systems. The impact of behavioral, family, and psychosocial contributors is understudied.
Objectives
We aimed to explore personal and contextual factors that drive glycemic outcomes among adolescents using AID technology.
Methods
Guided by Michie’s COM-B model and Bandura’s social cognitive theory, we used mixed methods to examine perspectives of teens (age 13-17 years) using AID for ≥1 year comparing those with time in range (TIR) ≥70% (n=8) or <45% (n=8). We conducted semi-structured interviews to assess device knowledge, attitudes toward devices, social support, family conflict, and financial resources. Interview transcripts were analyzed using a consensus coding approach to identify preliminary themes. We assessed device satisfaction, self-management, and diabetes-specific quality of life quantitatively with validated measures.
Results
Teens in both groups shared that 1) AIDs support but do not replace their personal responsibility for ongoing self-management; 2) alerts are frequent but often intrusive, creating both usefulness and frustration in daily life; 3) social context strongly influences management behaviors, balancing a need for support with a desire for privacy and normalcy. Key thematic differences lie in engagement and consistency. Teens with TIR ≥70% reported proactive and adaptive strategies to AID management and viewed parental monitoring as a sign of care. Teens with <45% described inconsistent dosing, increased reliance on AID to correct hyperglycemia, and annoyance with parental reminders. Quantitative measures echoed these findings: teens with TIR ≥70% reported higher quality of life and self-care, but similar device satisfaction compared to those with TIR <45%.
Conclusions
Glycemic outcomes among teens using AID appear to be driven less by device understanding or satisfaction and more by engagement and social context, highlighting the need for behavioral and family-centered interventions.