Low engagement and marginal glycemic benefits remain common challenges with DSS in T1DM. A randomized crossover study in Diabetes Research and Clinical Practice evaluated how human factors influence DSS use and whether informative or prescriptive formats affect glycemic outcomes.

Fifty-three adults using insulin injections (n = 26) or insulin pump therapy (n = 27) with continuous glucose monitoring (CGM) completed three 2-month intervention periods. The interventions included no DSS, iDSS that provided summary feedback, and prescriptive DSS (pDSS) that offered specific treatment suggestions. The primary outcomes were CGM-derived glycemic metrics. Exploratory analyses examined links between DSS engagement, psychosocial variables, and glycemic response.

Overall glycemic outcomes did not differ between intervention types. iDSS reduced average time >180 mg/dL by 6% in adults with lower diabetes-related knowledge (p < 0.001) and by 6% in those with higher hemoglobin A1c (p < 0.01). Emotional distress (p < 0.001) and hypoglycemia worry (p < 0.01) limited engagement with DSS. Participants engaged more with their preferred system, and 40% favored iDSS.

Informative feedback through iDSS may support learning and reduce hyperglycemia in adults with lower diabetes-related knowledge. Emotional distress and hypoglycemia worry may limit engagement with decision support systems.