Associations between insulin habit automaticity and insulin adherence in people with type 1 diabetes using ecological momentary assessment.

Abstract

Objective: New ways to reduce the burden of insulin therapy for people living with type 1 diabetes (T1D) are needed. Habit formation may support this objective by reducing the cognitive demand associated with taking insulin. This study aimed to understand whether insulin habit automaticity is associated with insulin adherence at mealtimes, which are a frequent and important time for insulin administration.

Method: Sixty-three adults with T1D completed momentary assessments three times daily for 7 days. Each assessment included questions related to the most recent meal context, cues, insulin use, and insulin habit automaticity using the Self-Report Behavioral Automaticity Index. Participants who reported not taking premeal insulin were prompted to explain their reason for omission. Momentary insulin adherence was assessed by self-report and review of device data.

Results: Insulin habit automaticity was positively correlated with insulin adherence (r = .26, p < .04). Variability in insulin habit automaticity was negatively associated with insulin adherence (r = -.47, p < .001) and positively associated with variability in insulin adherence (r = .47, p < .001). With every one-point increase in momentary insulin automaticity score, the likelihood of insulin adherence for a given meal increased by approximately 10%.

Conclusions: Our findings provide support that insulin habit automaticity may be important in more successful mealtime insulin adherence for people living with T1D and could be feasibly included in future ecological momentary assessment research. As insulin may be taken in a variety of contexts and in response to many cues, future studies are needed to understand factors that support the development of automaticity related to taking insulin. (PsycInfo Database Record (c) 2026 APA, all rights reserved).