(DCP047) IDENTIFYING BARRIERS TO CARBOHYDRATE COUNTING FOR PEOPLE WITH TYPE 1 DIABETES TO BRIDGE THE GAP WITH A CARBOHYDRATE COUNTING APP

Background: Type 1 diabetes (T1D) management requires daily insulin injections to maintain glycemic stability and prevent complications. Through carbohydrate counting (CC) methods, people with T1D can independently adapt mealtime insulin doses. While CC offers flexibility in eating habits, people with T1D perceive carbohydrate content estimation to be burdensome. To understand how a CC app can facilitate CC at mealtimes for people with T1D, we aim to identify 1) barriers to CC and 2) app-features that would help reduce such barriers.

METHODS AND RESULTS: People with T1D aged ≥14 years, were invited to complete a 30-close-ended questions survey to identify barriers to CC and inform the design of a CC app. Mean scores were computed to model correlations.

We analyzed the reported barriers of 169 participants (73% women, aged 40 ± 17 years, diabetes duration 23 ± 14 years, 89% relied on CC to determine insulin doses at mealtimes). These barriers were grouped under three overarching themes:

Carbohydrate identification barriers: Most participants encountered barriers in identifying the amount of carbohydrates in their meals when eating out (n=125, 74%), when unsure of how much they would eat (n=124, 73%), and when consuming foods without labels (n=117, 69%). These perceived barriers were significantly associated with the perception that photo-recognition app-features could facilitate CC (r=0.24, p=0.002).

Nutrient interaction and insulin dose calculation barriers: As fat and protein meal composition can influence the accuracy of CC in determining mealtime insulin, most participants encountered barriers in determining insulin doses for fat-rich (n=99, 59%) and protein-rich (n=75, 44%) meals. These perceived barriers were significantly associated with the perception that app-features quantifying the nutrient composition of a meal could facilitate CC and insulin dose calculation (r=0.17, p=0.025).

Psychosocial barriers: Several participants reported barriers to CC related to social stigma (n=45, 27%), continuously making insulin adjustments after mealtime (n=85, 5%0), and a lack of motivation to CC (n=77, 46%).These perceived barriers were significantly associated with the perception that gamification app-features could encourage CC (r=0.19, p=0.015).

Conclusion: Carbohydrate content identification, nutrient interaction and insulin dose calculations, as well as psychosocial factors were perceived by people with T1D as barriers to CC. Features such as photo recognition, quantification of nutrient meal composition, and gamification, could facilitate and encourage CC.