Decision-support for functional insulin therapy on multiple daily injections: an integrated qualitative study of patients and healthcare professionals

Diabetes technology innovation increasingly focuses on pumps and hybrid closed-loop systems, yet many people living with type 1 diabetes remain on basal–bolus multiple daily injections. Digital decision-support tools may extend algorithmic assistance to pen regimens, but evidence on their adoption and role in routine care remains limited. Integrated qualitative analysis of 25 semi-structured interviews collected in France (patients n=15; healthcare professionals n=10). Data were analysed using reflexive thematic analysis with cross-dataset comparison. Participants situated EkiYou, a mobile decision-support application for pen-treated regimens, within a hierarchised "innovation landscape" where pumps are seen as the most legitimate option. The application was valued—primarily by people with type 1 diabetes—for extending algorithmic support to pen users and reducing feelings of being "left behind". Its clearest contribution concerned functional insulin therapy: meal-entry and food-search routines, insulin-on-board, and personalised parameters scaffolded dose decisions, reducing dose-related uncertainty and meal-time anxiety for some, while adding time and attentional demands that most participants described as acceptable. Clinicians also used EkiYou as a bridge during pump–pen alternation and as a step toward calibrated trust in algorithmic recommendations. However, discontinuation occurred when the tool conflicted with embodied self-management routines, and food-database frictions were socially patterned. Time constraints in routine care and the need for nursing delegation appear as critical implementation determinants. EkiYou may act as a socio-technical scaffold for functional insulin therapy on pens and as a transition-support tool in an increasingly automated care environment. Scaling will require organisational support and attention to unequal capacities for sustained use.