{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:58:11Z","timestamp":1786121891979,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100013528","name":"Diabetes Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013528","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100032489","name":"Breakthrough T1D Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100032489","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advanced diabetes technologies are standard of care for people with Type 1 diabetes (T1D). However, inequitable access contributes to disparities in outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To characterise barriers and enablers to the use of advanced diabetes technologies among individuals with T1D and to synthesise these determinants using the Theoretical Domains Framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources<\/jats:title>\n                    <jats:p>EMBASE, Cochrane, PubMed, and MEDLINE were systematically searched from January 1, 2000, to September 30, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Selection<\/jats:title>\n                    <jats:p>We included studies of any design examining characteristics associated with the use of insulin pumps, continuous glucose monitors (CGM), or automated insulin delivery (AID) in T1D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Extraction<\/jats:title>\n                    <jats:p>Two reviewers independently screened and extracted data using a standardised tool. Determinants were categorised as non\u2010modifiable or potentially modifiable barriers or enablers. Modifiable determinants were mapped to TDF domains to enable theory\u2010informed synthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Synthesis<\/jats:title>\n                    <jats:p>\n                      Of 3081 citations identified, 303 studies (1\u2009864\u2009469 participants) were included. Non\u2010modifiable determinants most frequently associated with technology use included racial\/ethnic minority status (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200990), age (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200953), sex (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200936), and socioeconomic status (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940). Potentially modifiable determinants clustered primarily within six TDF domains, most commonly Environmental Context and Resources, Social Influences, Knowledge, Skills, Beliefs about Consequences, and Emotions. Within these domains, key barriers included financial constraints (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009117), provider gatekeeping and clinic processes (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200943), and physical burden or body image concerns (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200941). Key enablers included supportive patient\u2013provider relationships and shared decision\u2010making (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942), patient education and knowledge of device benefits (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940), and proactive provider engagement (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200924).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations<\/jats:title>\n                    <jats:p>A large proportion of abstracts (35.3% overall; 70.6% of interventions), potential publication bias, exclusion of grey literature, predominance of US\u2010based studies (62.4%), and few AID\u2010only studies (6.9%) may limit generalisability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Barriers to diabetes technology use map to key TDF domains, with structural factors predominating. Multilevel interventions targeting health system processes, provider practices, and education are needed to improve equitable uptake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70819","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T01:56:14Z","timestamp":1778032574000},"page":"6301-6311","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers and Enablers to Diabetes Technologies Use Among Individuals With Type 1 Diabetes: A Scoping Review"],"prefix":"10.1111","volume":"28","author":[{"given":"Laura","family":"Palermo","sequence":"first","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Mount Sinai Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyeuse","family":"Senga","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute Mount Sinai Hospital  Toronto 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