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Accessing Insulin Pump Therapy by Adults with Type 1 Diabetes in Ireland. A Multiphase Mixed Methods Study.

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posted on 2022-11-24, 15:09 authored by Katarzyna Gajewska

The overarching aim of this thesis was to explore the determinants of uptake and access to continuous subcutaneous insulin infusion (CSII) for adults with type 1 diabetes (T1D) in Ireland through a mixed methods multiphase study.

Methods: To explore this complex phenomenon in depth, the thesis consisted of 4 main objectives, 3 studies and 1 synthesis of all evidence. Study 1 was a quantitative secondary data analysis utilizing prescription-based data to estimate (1a) the epidemiology of T1D and (1b) uptake of CSII in adults with T1D. Study 2 investigated the availability of CSII in Irish adult diabetes centres through a national survey of diabetes clinics. Study 3 explored barriers and facilitators to accessing CSII by adults through semi-structured interviews with Health-Care Professionals (HCP) and other key stakeholders (OKS), and focus groups with People with type 1 Diabetes (PwD) from areas of low, medium and high uptake of CSII. Sampling was informed by the results of Studies 1 and 2. Qualitative data were analysed using the Reflexive Thematic Analysis approach. Finally, all evidence was synthesized within the Pillar Integration Process mixed methods synthesis.

Results: Studies 1 and 2 confirmed that the uptake of CSII is low in adults, and that there is inequality in access to CSII. Both uptake and availability of CSII are geographically heterogeneous. Study 3 explained the reasons for the diverse availability and uptake of CSII, and the synthesis summarized the determinants of access. These are: the impact of individual factors (either HCP or PwD, including their interest and personal characteristics, beliefs and motivation); capacity (mainly resources and expertise); structure (i.e. of the health-service – referrals, standardised pathways); awareness of CSII and its benefits; dwelling location; availability of CSII in local diabetes clinic(s); distance from and choice of clinic(s); health-services planning, access to and lessons from paediatric care and data monitoring (i.e. diabetes registry).

Conclusion: This PhD thesis provides evidence on the determinants of access to CSII and can inform policy-makers, health-services planners, HCP and PwD in Ireland on the complexity of access to CSII, and a current gap in Irish diabetes care delivery.


Structured Population and Health-services Research Education (SPHERE) Programme

Health Research Board

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First Supervisor

Prof. Seamus Sreenan

Second Supervisor

Prof. Kathleen Bennett

Third Supervisor

Dr Regien Biesma


Submitted for the Award of Doctor of Philosophy to the Royal College of Surgeons in Ireland, 2020

Published Citation

Gajewska K,. Accessing Insulin Pump Therapy by Adults with Type 1 Diabetes in Ireland. A Multiphase Mixed Methods Study. [PhD Thesis] Dublin: Royal College of Surgeons in Ireland; 2020

Degree Name

Doctor of Philosophy (PhD)

Date of award



  • Doctor of Philosophy (PhD)

Research Area

  • Endocrinology
  • Population Health and Health Services