572-P: Perspectives of People with Diabetes and Caregivers Experiencing Insulin Pump Infusion Set Failure (IPISF) : A Qualitative Study

Aim: IPISF can be a life-threatening complication and remains a serious issue for individuals who utilize automated insulin delivery (AID) systems. This study assessed the emotional burden of IPISF and how infusion failure affects sentiment towards insulin pump use. Methods: 50 follow-on interviews (10/2020 - 05/2021) were performed with Caregivers (CG) and People with Diabetes (PWD) from the 2020 Diatech Diabetes - T1D Exchange Insulin Pump Infusion Set Failure Management Survey. Participants consented to a 1-hour video call interview covering topics related to insulin pump use and experiences with infusion set failures. Audio recordings were transcribed using Trint Software and qualitative interview data was analyzed using thematic analysis, R, and Python. Results: 39 PWD and CG were interviewed (PWD age 40.1±20.9 years, CG age 46.2±6.3 years, 72% female, 72% white, 50% household income ≥$100K/year, CSII use for 11.5±8.2 years, 48% use AID, HbA1c 6.9±1.4%, TIR 69.9±18.9%, infusion set wear time 2.9±0.8 days, 62% having ≥1 IPISF/month) . Participants shared quotes on how IPISF is “a direct correlation to my level of happiness...kind of irks me and just makes me angry...because as the caregiver, it's my responsibility to make sure that it goes right” and technology that reduces IPISF and improves detection “would probably be the first step in making me even reconsider going back on the pump.” Identified themes showcase the burden of diagnosing and managing infusion failures when overcoming existing alarm fatigue, trusting care team input, and general stress of CSII therapy. Conclusions: IPISF’s clinical impact is associated with hyperglycemia and DKA, yet IPISF can also affect the mental health of people who use CSII therapy. CSII users heavily rely on hyperglycemia to detect IPISF and can have issues identifying true IPISF from other confounding factors, thus increasing the risk of CSII therapy and justifying the need for better IPISF detection.