Assessing attitudes towards insulin pump therapy in adults with type 1 diabetes: Italian validation of the Insulin Pump Attitudes Questionnaire (IT-IPA questionnaire)

Abstract

Aims: The aim of the study was to adapt the German version of the insulin pump therapy (IPA) questionnaire to Italian (IT-IPA) and to evaluate its psychometric properties in adults with type 1 diabetes.

Methods: We conducted a cross-sectional study, data were collected through an online survey. In addition to IT-IPA, questionnaires evaluating depression, anxiety, diabetes distress, self-efficacy, and treatment satisfaction were administered. The six factors identified in the IPA German version were assessed using confirmatory factor analysis; psychometric testing included construct validity and internal consistency.

Results: The online survey was compiled by 182 individuals with type 1 diabetes: 45.6% continuous subcutaneous insulin infusion (CSII) users and 54.4% multiple daily insulin injection users. The six-factor model had a very good fit in our sample. The internal consistency was acceptable (Cronbach's α = 0.75; 95% IC [0.65-0.81]). Diabetes treatment satisfaction was positively correlated with a positive attitude towards CSII therapy (Spearman's rho = 0.31; p < 0.01), less Technology Dependency, higher Ease of Use, and less Impaired Body Image. Furthermore, less Technology Dependency was associated with lower diabetes distress and depressive symptoms.

Conclusions: The IT-IPA is a valid and reliable questionnaire evaluating attitudes towards insulin pump therapy. The questionnaire can be used for clinical practice during consultations for shared decision-making to CSII therapy.

Keywords: Attitudes; Insulin pump therapy; Psychometric validation; Psychosocial aspects; Type 1 diabetes.

Fig. 1

Comparison of IPA subscale scores between CSII users and MDI users. IPA Insulin Pump Attitudes, IPA subscales GC Glycaemic Control, TD (inv) Technology Dependency (inverted score), EoU Ease of Use, Fle Flexibility, Fun Functionality, BI (inv) Impaired Body Image (inverted score), MDI multiple daily insulin injections, CSII Continuous subcutaneous insulin infusion

Fig. 2

Structure of the Insulin Pump Attitudes (IPA) questionnaire resulting from the confirmatory factor analysis (standardized estimates). IBI = Impaired Body Image; Fun = Functionality; Fle = Flexibility; EoU = Ease of Use; TD = Technology Dependency; GC = Glycaemic Control. GC (IPA_7: With the insulin pump I can achieve better fasting glucose in the morning; IPA_8: With the insulin pump I can avoid hypoglycaemia more easily; IPA_9: With an insulin pump, I can avoid glucose/blood sugar fluctuations more easily; IPA _11: With an insulin pump I can achieve a better HbA1c; IPA _10: With the insulin pump I can better avoid large glucose/blood sugar excursions after a meal); TD (IPA _17: I'm constantly worried that my insulin pump might become defective; IPA _19: The pump alarms make me feel worried; IPA _21: I often worry about my insulin tubing becoming clogged or my insulin catheter kinking); EoU (IPA _24: The handling of my insulin pump is easy; IPA _25: The operation of the insulin pump was/is easy to learn; IPA _26: The handling of the insulin pump is intuitive); Fle (IPA _1: With an insulin pump, I have more Flexibility in my daily routine; IPA _2: With an insulin pump, I can do sports more spontaneously; IPA _3: With an insulin pump, I need less preparation for my sport; IPA _4: With the insulin pump, I can manage my glucose/blood glucose levels after a physical activity much better; IPA _5: With an insulin pump, I can respond to unexpected situations much better; IPA _6: With an insulin pump, I can organize my free time more flexibly); Fun (IPA _12: For the insulin pump, it’s important to me that I can program several basal rate profiles; IPA _13: For the insulin pump, it’s important to me that I can adjust the temporary basal rate as easily as possible; IPA _14: Regarding the insulin pump, it's important to me that it can be paired with a bolus calculator; IPA _15: For the insulin pump, it’s important to me that it can be paired with a continuous glucose measurement system); IBI (IPA _16: The insulin pump makes me feel more ill; IPA _18: It bothers me that I constantly have an insulin catheter in my body; IPA _20: Because of the insulin pump, others can immediately see that I have diabetes; IPA _22: The insulin pump disturbs my sleep; IPA _23: The insulin pump makes me feel less attractive)