What question did this study set out to answer?

To explore provider-level barriers and enablers influencing technology initiation among socially disadvantaged adults with type 1 diabetes.

June 13, 2026

2038-P: Provider Barriers and Enablers for Initiating Technologies among Socially Disadvantaged Adults with Type 1 Diabetes: A Qualitative Study in Ontario and Québec

Key Points

To explore provider-level barriers and enablers influencing technology initiation among socially disadvantaged adults with type 1 diabetes.
Conducted twenty-nine semi-structured interviews with endocrinologists and certified diabetes educators in English and French.
Utilized purposive sampling for participant selection across Ontario and Québec.
Analyzed interview transcripts deductively using the Theoretical Domains Framework.
Endocrinologists identified barriers, including non-standard initiation workflows and safety concerns, affecting their confidence in recommending insulin pumps over CGM.
CDEs noted challenges with cognitive overload when assisting disadvantaged patients but reported confidence in initiating pumps.
Cross-cutting themes included perceived socioeconomic constraints affecting access to education materials and provider advocacy needs.

Abstract

Introduction and Objective: Lower uptake of diabetes technologies among socially disadvantaged adults with type 1 diabetes (T1D) may be partly driven by provider-level barriers. This study examined barriers and enablers influencing providers’ initiation of continuous glucose monitoring (CGM), insulin pumps, and automated insulin delivery (AID). Methods: We conducted twenty-nine semi-structured interviews in English and French with purposively sampled endocrinologists (n = 16) and certified diabetes educators (CDEs; n = 13) in Ontario and Québec. Two analysts independently coded transcripts deductively using the Theoretical Domains Framework. Results: Data saturation was achieved across interviews with endocrinologists and CDEs. Endocrinologists reported barriers including lack of standardized initiation workflows, limited technical involvement in pump initiation, and lower confidence initiating pumps compared with CGM, driven by safety and socioeconomic concerns. Facilitators included positive clinical feedback, interprofessional collaboration, and viewing AID as standard of care. CDEs reported greater confidence initiating pumps but experienced cognitive and emotional overload when supporting socially disadvantaged patients. Facilitators included active roles in pump training, frequent technology discussions, and standardized processes. Cross-cutting themes included gatekeeping driven by perceived socioeconomic constraints, limited access to tailored or translated education materials, challenges navigating coverage and social supports, and provider advocacy beyond clinical roles. Conclusion: Provider role, confidence, and system-level constraints shape technology initiation for socially disadvantaged adults with T1D. Interventions addressing workflows, team roles, education resources, and policy navigation may reduce inequities in technology uptake. Disclosure J. Senga: None. P. Fakembe: None. A. Benzaquen: None. X.M. Zhu: None. W. Cheema: None. C.E. MacGibbon: None. R. Shulman: None. L. Lipscombe: None. M. Nakhla: None. M. Dogba: None. L. Lovblom: None. A. Brazeau: Research Support; Current; Canadian Institutes of Health Research, Société Francophone du Diabète, Diabète Québec. Research Support; Ended; Mitacs. Speaker's Bureau; Ended; dexcom canada. H. Witteman: None. J. Presseau: None. A. Weisman: None. Funding Diabetes Canada End Diabetes Award, Canadian Institutes of Health Research (CIHR), Breakthrough T1D Canada

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