Future acceptance of automated insulin delivery systems in youths with type 1 diabetes: validation of the Italian artificial pancreas-acceptance measure

Roberto Franceschi; Riccardo Pertile; Marco Marigliano; Enza Mozzillo; Claudio Maffeis; Silvana Zaffani; Carlotta Dusini; Annalisa Antonelli; Francesca Di Candia; Giulio Maltoni; Erika Cantarelli; Nicola Minuto; Marta Bassi; Ivana Rabbone; Silvia Savastio; Stefano Passanisi; Fortunato Lombardo; Valentino Cherubini; Maria Alessandra Saltarelli; Stefano Tumini

doi:10.1007/s00592-024-02327-9

Future acceptance of automated insulin delivery systems in youths with type 1 diabetes: validation of the Italian artificial pancreas-acceptance measure

Acta Diabetol. 2024 Aug 10. doi: 10.1007/s00592-024-02327-9. Online ahead of print.

Authors

Roberto Franceschi^#¹, Riccardo Pertile^#², Marco Marigliano³, Enza Mozzillo^#⁴, Claudio Maffeis⁵, Silvana Zaffani⁵, Carlotta Dusini¹, Annalisa Antonelli⁶, Francesca Di Candia⁴, Giulio Maltoni⁷, Erika Cantarelli⁷, Nicola Minuto⁸, Marta Bassi⁸, Ivana Rabbone⁹, Silvia Savastio⁹, Stefano Passanisi¹⁰, Fortunato Lombardo¹⁰, Valentino Cherubini¹¹, Maria Alessandra Saltarelli⁶, Stefano Tumini⁶

Affiliations

¹ Department of Pediatrics, S.Chiara Hospital of Trento, APSS, Trentino-Alto Adige, Trento, Italy.
² Clinical and Evaluative Epidemiology Unit, Health Management, APSS, Trento, Italy.
³ Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Piazzale Aristide Stefani 1, Verona, 37126, Italy. marco.marigliano@univr.it.
⁴ Department of Translational Medical Science, Section of Pediatrics, Università degli Studi di Napoli Federico II, Naples, Italy.
⁵ Department of Surgery, Dentistry, Pediatrics, and Gynecology, Section of Pediatric Diabetes and Metabolism, University of Verona, Piazzale Aristide Stefani 1, Verona, 37126, Italy.
⁶ Department of Maternal and Child Health, UOSD Regional Center of Pediatric Diabetology, "SS Annunziata" Hospital, Chieti, Italy.
⁷ Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
⁸ Pediatric Clinic, Department of Neuroscience Rehabilitation Ophthalmology Genetics, Maternal and Child Health, IRCCS Giannina Gaslini, University of Genoa, Genova, Italy.
⁹ Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
¹⁰ Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy.
¹¹ Department of Women's and Children's Health, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, "G. Salesi Hospital", Ancona, Italy.

^# Contributed equally.

PMID: 39126517
DOI: 10.1007/s00592-024-02327-9

Abstract

Aim: The purpose of this study was to develop a questionnaire to examine the future acceptance of Automatic insulin delivery systems (AIDs), their perceived usefulness, ease of use, and trust in the device in subjects with type 1 diabetes (T1D).

Methods: A questionnaire in Italian, based on the Technology Acceptance Model, was developed to examine intention to use AIDs, considered as a measure of future acceptance, and its determinants to use the system. A total of 43 questions for children and 46 for parents were included, and a 5-point Likert scale was used.

Results: 239 subjects with T1D using multiple daily injections (MDI) or sensor-augmented pump (SAP) and their parents completed the questionnaire. The completion rate was excellent, with almost 100% of items answered. The overall Cronbach's coefficient for children and adolescents was 0.92 and 0.93 for parents, indicating excellent internal consistency in both groups. Parent-youth agreement was 0.699 (95% confidence interval: 0.689-0.709), indicating a good agreement between the two evaluations. Factor analysis identified measurement factors for the "artificial pancreas (AP)-acceptance labeled benefits and hassles of AIDs, and the internal consistency of the total scale was alpha = 0.94 for subjects with T1D and 0.95 for parents. The level of AP acceptance was more than neutral: 3.91 ± 0.47 and 3.99 ± 0.43 (p = 0.07) for youths and parents, respectively (possible score range 1 to 5, neutral score is 3.0). Parents reported higher scores in the benefit items than children-adolescents (p = 0.04).

Conclusions: We developed a new questionnaire based on the items available in the literature, and we demonstrated that the "AP-acceptance" reveals a meaningful factor structure, good internal reliability, and agreement between parent-young people evaluations. This measure could be a valuable resource for clinicians and researchers to assess AP acceptance in pediatric patients with T1D and their parents. This patient profiling approach could help to enroll candidates for AIDs with proper expectations and who most likely will benefit from the system.

Keywords: AID; Acceptance; Adolescents; Artificial pancreas; CSII; Child; Insulin pump; Technology.