Attitudes and Reasons for Device Uptake in T1D
Maaike Horsselenberg, Judith Prins, Marianne Boenink, Henk-Jan Aanstoot and Giesje Nefs
Clustering of technological attitudes and reasons for device (non-)uptake among Dutch people with type 1 diabetes, family members and health professionals. Diabet Med. 2026 Jun 3:e70375.
Insulin pumps and glucose sensors — including advanced hybrid closed loop (HCL) systems — have demonstrated meaningful benefits for glycaemic control and quality of life in people with type 1 diabetes (T1D). Yet uptake in the Netherlands remains limited, with insulin pump use at 21% and real-time continuous glucose monitoring at just 10% in the adult population in 2023. Individual attitudes, expectations and experiences with diabetes technology play a key role in device uptake and continuation. To move beyond a one-size-fits-all support approach, this study — conducted by researchers from Radboud University Medical Center, Tilburg University, and Diabeter — mapped how technology-related attitudes and reasons for non-uptake cluster into distinct subgroups among people with T1D, their parents and partners, and healthcare providers (HCPs) in the Dutch healthcare setting.
An anonymous online survey was completed by 219 people with T1D (aged 12+), 55 parents and partners (P/P), and 118 HCPs. K-means cluster analyses were performed separately for each group, based on technological attitudes and reasons for device non-uptake (for people with T1D and P/P) or technological readiness (for HCPs). Clusters were validated against demographic, clinical and psychosocial characteristics.
Key findings:
- Positive attitudes are the norm, but meaningful subgroups with concerns exist: The largest subgroup in each sample held positive technological attitudes and reported few barriers to device use (31–67% of each group). However, a minority with more negative perceptions was consistently identified, and their specific concerns differed in important ways.
- Three distinct subgroups were identified among people with T1D: The largest group, 'Comfortable Tech-users' (60%), had the most positive attitudes, highest time-in-range, greatest perceived support from family and HCPs, and most frequent HCL use. A second group, 'Reluctant Wearers' (31%), had broadly positive attitudes but were specifically burdened by the physical experience of wearing devices, and reported the highest diabetes distress. The smallest group, 'Concerned Traditionals' (9%), held broadly negative technological attitudes, reported multiple co-occurring barriers to device use, had the lowest perceived support, and used HCL least often.
- Two subgroups emerged among parents and partners: 'Tech Supportive P/P' (67%) held positive attitudes, had lower hypoglycaemia worries, and their child or partner more often used advanced technology. 'Concerned Traditional P/P' (31%) had more negative attitudes, were particularly anxious about device reliance, had more hypoglycaemia worries, and their relative more often used an insulin pen.
- Four subgroups were identified among HCPs: 'Ready HCPs' (31%) had both positive attitudes and high readiness, and saw the most T1D patients per week. 'Novice Enthusiasts' (34%) had positive attitudes but felt not yet ready — a new finding compared to earlier US-based research. 'Doubting HCPs' (20%) had negative attitudes and the lowest readiness, and included a disproportionate number of psychologists. 'Traditional HCPs' (15%) had the most negative attitudes and saw fewer T1D patients per week, with a higher proportion of dieticians.
- Device wear burden deserves specific attention: The 'Reluctant Wearer' subgroup highlights that for a substantial proportion of people with T1D, the primary barrier is not general technology aversion but specifically the bodily experience of wearing devices — a concern that is unlikely to diminish as newer systems continue to rely on multiple worn components.
- HCP readiness is a distinct and actionable gap: The 'Novice Enthusiasts' subgroup — enthusiastic but not yet ready — suggests that many HCPs are motivated to support technology use but need structured training and updated knowledge to do so effectively.
This study provides a contemporary, Dutch-specific map of technology attitudes across the full ecosystem of T1D care — patients, families and professionals — in the era of advanced HCL systems. The findings suggest that support should be tailored not only to whether someone has concerns, but to what kind of concerns they have.
Concluding, the authors state
"In the era of advanced diabetes technologies, positive attitudes and experiences appear most common among people with T1D, family members and HCPs. However, when present, negative technology perceptions either co-occur or focus on the burden of wear. This advocates for general as well as wear-specific support for people with T1D." -
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