Use of Systems Thinking and Group Model Building Methods to Understand Patterns of Continuous Glucose Monitoring Use Among Older Adults with Type 1 Diabetes

A growing number of older adults (ages 65+ years) live with Type 1 diabetes, yet little is known about the complex dynamics that promote use of diabetes technology, such as continuous glucose monitoring (CGM), in this age group. We used systems thinking and methods from group model building (GMB), a participatory approach to system dynamics modeling, to collect data from older adults with Type 1 diabetes and their caregivers through group workshops and individual validation interviews. Data were integrated into a causal loop diagram of the “system” of factors associated with CGM uptake and use, including the clinical and psychosocial outcomes of use and interactions with caregiver and healthcare system factors. We describe the study design, recruitment, GMB and interview procedures, participant feedback, and lessons learned. The study demonstrates feasibility, acceptability, and the value of GMB to engage older adult stakeholders in sophisticated and rigorous research about key determinants of complex health outcomes over time. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement ARK is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR002490. The project was supported by UL1TR002489 from the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health and the Diabetes Research Connection. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The IRB of the University of North Carolina at CHapel Hill get ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.