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Tanenbaum ML, Commissariat PV, Wilmot EG, Lange K. Navigating the Unique Challenges of Automated Insulin Delivery Systems to Facilitate Effective Uptake, Onboarding, and Continued Use. J Diabetes Sci Technol 2024:19322968241275963. [PMID: 39212371 DOI: 10.1177/19322968241275963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Advances in diabetes technologies have enabled automated insulin delivery (AID) systems, which have demonstrated benefits to glycemia, psychosocial outcomes, and quality of life for people with type 1 diabetes (T1D). Despite the many demonstrated benefits, AID systems come with their own unique challenges: continued user attention and effort, barriers to equitable access, personal costs vs benefits, and integration of the system into daily life. The purpose of this narrative review is to identify challenges and opportunities for supporting uptake and onboarding of AID systems to ultimately support sustained AID use. Setting realistic expectations, providing comprehensive training, developing willingness to adopt new treatments and workflows, upskilling of diabetes team members, and increasing flexibility of care to tailor care to individual needs, preferences, lifestyle, and personal goals will be most effective in facilitating effective, widespread, person-centered implementation of AID systems.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Persis V Commissariat
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, USA
| | - Emma G Wilmot
- Academic Unit of Translational Medical Sciences, School of Medicine, University of Nottingham, University of Nottingham, Nottingham, UK
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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Xu T, Jost E, Messer LH, Cook PF, Forlenza GP, Sankaranarayanan S, Fiesler C, Voida S. "Obviously, Nothing's Gonna Happen in Five Minutes": How Adolescents and Young Adults Infrastructure Resources to Learn Type 1 Diabetes Management. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:139. [PMID: 38846748 PMCID: PMC11153724 DOI: 10.1145/3613904.3642612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Learning personalized self-management routines is pivotal for people with type 1 diabetes (T1D), particularly early in diagnosis. Context-aware technologies, such as hybrid closed-loop (HCL) insulin pumps, are important tools for diabetes self-management. However, clinicians have observed that practices using these technologies involve significant individual differences. We conducted interviews with 20 adolescents and young adults who use HCL insulin pump systems for managing T1D, and we found that these individuals leverage both technological and non-technological means to maintain situational awareness about their condition. We discuss how these practices serve to infrastructure their self-management routines, including medical treatment, diet, and glucose measurement-monitoring routines. Our study provides insights into adolescents' and young adults' lived experiences of using HCL systems and related technology to manage diabetes, and contributes to a more nuanced understanding of how the HCI community can support the contextualized management of diabetes through technology design.
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Affiliation(s)
- Tian Xu
- Information Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Emily Jost
- University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | - Laurel H Messer
- University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | - Paul F Cook
- University of Colorado Anschutz, Medical Campus, Aurora, Colorado, USA
| | | | | | - Casey Fiesler
- Information Science, University of Colorado Boulder, Boulder, Colorado, USA
| | - Stephen Voida
- Information Science, University of Colorado Boulder, Boulder, Colorado, USA
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Hendrieckx C, Husin HM, Russell-Green S, Halliday JA, Lam B, Trawley S, McAuley SA, Bach LA, Burt MG, Cohen ND, Colman PG, Holmes-Walker DJ, Jenkins AJ, Lee MH, McCallum RW, Stranks SN, Sundararajan V, Jones TW, O'Neal DN, Speight J. The diabetes management experiences questionnaire: Psychometric validation among adults with type 1 diabetes. Diabet Med 2024; 41:e15195. [PMID: 37562414 DOI: 10.1111/dme.15195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023]
Abstract
AIMS To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME-Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME-Q captures satisfaction with diabetes management irrespective of treatment modalities. METHODS The DME-Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre-randomization data (n = 149); responsiveness was examined using baseline and 26-week follow-up data (n = 120). RESULTS Pre-randomization, participants' mean age was 44 ± 12 years, 52% were women. HbA1c was 61 ± 11 mmol/mol (7.8 ± 1.0%), diabetes duration was 24 ± 12 years and 47% used an insulin pump prior to the trial. A forced three-factor analysis revealed three expected domains, that is, 'Convenience', 'Effectiveness' and 'Intrusiveness', and a forced one-factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales (α range = 0.74-0.84) and 'Total satisfaction'( α = 0.85). Convergent validity was demonstrated with moderate correlations between DME-Q 'Total satisfaction' and diabetes distress (PAID: rs = -0.57) and treatment satisfaction (DTSQ; rs = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: rs = -0.16 and - 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher 'Effectiveness' and 'Total satisfaction' scores than those randomized to standard therapy. CONCLUSIONS The 22-item DME-Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME-Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings.
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Affiliation(s)
- Christel Hendrieckx
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
| | - Hanafi M Husin
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
| | - Sienna Russell-Green
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
| | - Jennifer A Halliday
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
| | - Benjamin Lam
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Education Futures, University of South Australia, Adelaide, Australia
| | - Steven Trawley
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Sybil A McAuley
- The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Leon A Bach
- Department of Endocrinology and Diabetes, The Alfred, Melbourne, Australia
- Department of Medicine (Alfred Medical Research and Education Precinct), Monash University, Melbourne, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- School of Pharmacy, University of Queensland, Woolloongabba, Australia
| | - Peter G Colman
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - D Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Alicia J Jenkins
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Melissa H Lee
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Roland W McCallum
- Department of Diabetes and Endocrinology, Royal Hobart Hospital, Hobart, Australia
| | - Steve N Stranks
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | - Tim W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - David N O'Neal
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jane Speight
- School of Psychology, Deakin University, Victoria, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Victoria, Carlton, Australia
- Institute for Health Transformation, Deakin University, Victoria, Geelong, Australia
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Wilkinson T, Tomic D, Boyle E, Burren D, Elghattis Y, Jenkins A, Keesing C, Middleton S, Nanayakkara N, Williman J, de Bock M, Cohen ND. Study protocol for a randomised open-label clinical trial examining the safety and efficacy of the Android Artificial Pancreas System (AAPS) with advanced bolus-free features in adults with type 1 diabetes: the 'CLOSE IT' (Closed Loop Open SourcE In Type 1 diabetes) trial. BMJ Open 2024; 14:e078171. [PMID: 38382954 PMCID: PMC10882371 DOI: 10.1136/bmjopen-2023-078171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/20/2023] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Multiple automated insulin delivery (AID) systems have become commercially available following randomised controlled trials demonstrating benefits in people with type 1 diabetes (T1D). However, their real-world utility may be undermined by user-associated burdens, including the need to carbohydrate count and deliver manual insulin boluses. There is an important need for a 'fully automated closed loop' (FCL) AID system, without manual mealtime boluses. The (Closed Loop Open SourcE In Type 1 diabetes) trial is a randomised trial comparing an FCL AID system to the same system used as a hybrid closed loop (HCL) in people with T1D, in an outpatient setting over an extended time frame. METHODS AND ANALYSIS Randomised, open-label, parallel, non-inferiority trial comparing the Android Artificial Pancreas System (AAPS) AID algorithm used as FCL to the same algorithm used as HCL. Seventy-five participants aged 18-70 will be randomised (1:1) to one of two treatment arms for 12 weeks: (a) FCL-participants will be advised not to bolus for meals and (b) HCL-participants will use the AAPS AID algorithm as HCL with announced meals. The primary outcome is the percentage of time in target sensor glucose range (3.9-10.0 mmol/L). Secondary outcomes include other glycaemic metrics, safety, psychosocial factors, platform performance and user dietary factors. Twenty FCL arm participants will participate in a 4-week extension phase comparing glycaemic and dietary outcomes using NovoRapid (insulin aspart) to Fiasp (insulin aspart and niacinamide). ETHICS AND DISSEMINATION Approvals are by the Alfred Health Ethics Committee (615/22) (Australia) and Health and Disability Ethics Committees (2022 FULL 13832) (New Zealand). Each participant will provide written informed consent. Data protection and confidentiality will be ensured. Study results will be disseminated by publications, conferences and patient advocacy groups. TRIAL REGISTRATION NUMBERS ACTRN12622001400752 and ACTRN12622001401741.
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Affiliation(s)
- Tom Wilkinson
- University of Otago Christchurch, Christchurch, New Zealand
| | - Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Erin Boyle
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David Burren
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yasser Elghattis
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Alicia Jenkins
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | - Sonia Middleton
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | | | - Martin de Bock
- University of Otago Christchurch, Christchurch, New Zealand
| | - Neale D Cohen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Donovan LE, Feig DS, Lemieux P, Murphy HR, Bell RC, Sigal RJ, Ho J, Virtanen H, Crawford S, Yamamoto JM. A Randomized Trial of Closed-Loop Insulin Delivery Postpartum in Type 1 Diabetes. Diabetes Care 2023; 46:2258-2266. [PMID: 37824779 DOI: 10.2337/dc23-0882] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of closed-loop insulin delivery postpartum. RESEARCH DESIGN AND METHODS In this open-label, randomized controlled trial, postpartum individuals with type 1 diabetes were randomized to hybrid closed-loop insulin delivery with the MiniMed 670G/770G system in automode or sensor-augmented pump therapy in the first 12-weeks postpartum followed by a continuation phase with closed-loop insulin delivery for all until 24 weeks postpartum. RESULTS Eighteen participants (mean ± SD age 32 ± 3.5 years, diabetes duration 22 ± 7.3 years, and early pregnancy HbA1c 52 ± 6.8 mmol/mol [6.9 ± 0.9%]) completed 24 weeks of postpartum follow-up. In the randomized phase, percent time in range 70-180 mg/dL (3.9-10 mmol/L) did not differ between groups (79.2 ± 8.7% vs. 78.2 ± 6.0%; P = 0.41). Participants randomized to closed-loop insulin delivery spent less time <70 mg/dL (3.9 mmol/L) and <54 mg/dL (3.0 mmol/L) (1.7 ± 0.8% vs. 5.5 ± 3.3% [P < 0.001] and 0.3 ± 0.2% vs. 1.1 ± 0.9% [P = 0.008]). Time >180 mg/dL (10 mmol/L) was not different between groups (18.7 ± 8.8% vs. 15.9 ± 7.7%; P = 0.21). In the continuation phase, those initially randomized to sensor-augmented pump therapy had less time <70 mg/dL after initiation of closed-loop insulin delivery (5.5 ± 3.3% vs. 3.3 ± 2.2%; P = 0.039). The closed-loop group maintained similar glycemic metrics in both study phases. There were no episodes of diabetic ketoacidosis or severe hypoglycemia in the randomized or continuation phase in either group. CONCLUSIONS Women randomized to closed-loop insulin delivery postpartum had less hypoglycemia than those randomized to sensor-augmented pump therapy. There were no safety concerns. These findings are reassuring for use of closed-loop insulin delivery postpartum because of its potential to reduce hypoglycemia.
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Affiliation(s)
- Lois E Donovan
- Departments of Medicine and Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Denice S Feig
- Department of Medicine, University of Toronto; Lunenfeld-Tanenbaum Research Institute; and Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Patricia Lemieux
- Department of Medicine, University Laval, Quebec City, Quebec, Canada
| | - Helen R Murphy
- Norwich Medical School, University of East Anglia, Norwich, U.K
| | - Rhonda C Bell
- Li Ka Shing Centre for Health Research Innovation, Division of Human Nutrition, Department of Agricultural, Food, and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ronald J Sigal
- Departments of Medicine, Cardiac Sciences, and Community Health Sciences, Cumming School of Medicine, Faculties of Medicine and Kinesiology, University of Calgary, Canada
| | - Josephine Ho
- Departments of Pediatrics and Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heidi Virtanen
- Departments of Pediatrics and Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Jennifer M Yamamoto
- Department of Internal Medicine, University of Manitoba and Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Winterdijk P, Aanstoot HJ, Nefs G. The impact of real-time sensor technology on quality of life for adults with type 1 diabetes: A Dutch national survey. Diabetes Res Clin Pract 2023; 203:110886. [PMID: 37604282 DOI: 10.1016/j.diabres.2023.110886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIMS To examine the impact of real-time continuous glucose monitoring (RT-CGM) on quality of life in Dutch adults with type 1 diabetes, inside/outside automated insulin delivery (AID) systems. METHODS In this cross-sectional retrospective observational study, RT-CGM users completed an online survey including (adapted) validated questionnaires, study-specific items and open-ended questions. RESULTS Of 893 participating adults, 69% used the RT-CGM as part of AID. The overall sample reported improvements in quality of life related to RT-CGM use (irrespective of initial indication), particularly with respect to physical health, emotional wellbeing and energy. Merits for sleep, intimacy and cognitive diabetes load lagged somewhat behind, mostly when RT-CGM was not integrated in AID. Users of AID had significantly larger improvements in overall quality of life, fatigue and diabetes-specific distress than users of sensor-augmented pump or Open Loop treatment. In regression analyses, user evaluations were associated with perceptions of benefit and burden. In qualitative content analysis, benefits (e.g. life 'normalization', increased perceptions of control) outweighed burdens (e.g. technology frustrations, confrontation with diabetes). CONCLUSIONS RT-CGM positively impacted the quality of life of adults with type 1 diabetes. This justifies a (re-)consideration of broader access. Increased support to maximize device benefits and minimize burdens is also warranted.
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Affiliation(s)
- Per Winterdijk
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Henk-Jan Aanstoot
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Giesje Nefs
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands; Radboud University Medical Center, Department of Medical Psychology, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, PO Box 90153, 5000 LE Tilburg, the Netherlands.
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Marigliano M, Mozzillo E, Mancioppi V, Di Candia F, Rosanio FM, Antonelli A, Nichelatti I, Maffeis C, Tumini S, Franceschi R. Measures of Patient-Reported Expectations, Acceptance, and Satisfaction Using Automated Insulin Delivery Systems: A Review. J Pers Med 2023; 13:1031. [PMID: 37511644 PMCID: PMC10382040 DOI: 10.3390/jpm13071031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 07/30/2023] Open
Abstract
In people with type 1 diabetes, Automated Insulin Delivery (AID) systems adjust insulin delivery in response to sensor glucose data and consist of three components: an insulin pump, a continuous glucose sensor, and an algorithm that determines insulin delivery. To date, all the available AID systems require users to announce carbohydrate intake and deliver meal boluses, as well as respond to system alarms. The use of AID devices both initially and over time may be influenced by a variety of psychological factors. Analysis of patient-related outcomes should be taken into account, while recruiting applicants for the systems who are motivated and have realistic expectations in order to prevent AID dropout. We report an up-to-date summary of the available measures and semi-structured interview content to assess AID expectations, acceptance, and satisfaction using the AID systems. In conclusion, we suggest, before and after starting using AID systems, performing a specific evaluation of the related psychological implications, using validated measures and semi-structured interviews, that allows diabetes care providers to tailor their education approach to the factors that concern the patient at that time; they can teach problem-solving skills and other behavioral strategies to support sustained use of the AID system.
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Affiliation(s)
- Marco Marigliano
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | - Valentina Mancioppi
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Francesca Di Candia
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | - Francesco Maria Rosanio
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, Federico II University of Naples, 80138 Naples, Italy
| | - Annalisa Antonelli
- Department of Maternal and Child Health, UOSD Regional Center of Pediatric Diabetology, Chieti Hospital, 66100 Chieti, Italy
| | - Ilaria Nichelatti
- Pediatric Diabetology Unit, Pediatric Department, S.Chiara General Hospital of Trento, Azienda Provinciale per i Servizi Sanitari, 38122 Trento, Italy
| | - Claudio Maffeis
- Department of Surgery, Dentistry, Pediatrics and Gynecology, Section of Pediatric Diabetes and Metabolism, University and Azienda Ospedaliera Universitaria Integrata of Verona, 37126 Verona, Italy
| | - Stefano Tumini
- Department of Maternal and Child Health, UOSD Regional Center of Pediatric Diabetology, Chieti Hospital, 66100 Chieti, Italy
| | - Roberto Franceschi
- Pediatric Diabetology Unit, Pediatric Department, S.Chiara General Hospital of Trento, Azienda Provinciale per i Servizi Sanitari, 38122 Trento, Italy
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Kubilay E, Trawley S, Ward GM, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Vogrin S, Colman PG, McAuley SA. Lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery in a randomised trial. Diabet Med 2023; 40:e15020. [PMID: 36468784 DOI: 10.1111/dme.15020] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/25/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
AIM To explore the lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery, an area previously receiving minimal attention. METHODS Semi-structured interviews were conducted with adults aged 60 years or older with long-duration type 1 diabetes who participated in a randomised, open-label, two-stage crossover trial comparing first-generation closed-loop therapy (MiniMed 670G) versus sensor-augmented pump therapy. Interview recordings were transcribed, thematically analysed and assessed. RESULTS Twenty-one older adults participated in interviews after using closed-loop therapy. Twenty were functionally independent, without frailty or major cognitive impairment; one was dependent on caregiver assistance, including for diabetes management. Quality of life benefits were identified, including improved sleep and reduced diabetes-related psychological burden, in the context of experiencing improved glucose levels. Gaps between expectations and reality of closed-loop therapy were also experienced, encountering disappointment amongst some participants. The cost was perceived as a barrier to continued closed-loop access post-trial. Usability issues were identified, such as disruptive overnight alarms and sensor inaccuracy. CONCLUSIONS The lived experience of older adults without frailty or major cognitive impairment using first-generation closed-loop therapy was mainly positive and concordant with glycaemic benefits found in the trial. Older adults' lived experience using automated insulin delivery beyond trial environments requires exploration; moreover, the usability needs of older adults should be considered during future device development.
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Affiliation(s)
- Erin Kubilay
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
| | - Steven Trawley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Australia
| | - Charlotte A Grills
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Melissa H Lee
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Richard J MacIsaac
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Australia
| | - David N O'Neal
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Niamh A O'Regan
- Department of Geriatric Medicine, Waterford Integrated Care for Older People, University Hospital Waterford, Waterford, Ireland
| | - Vijaya Sundararajan
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Sara Vogrin
- Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - Sybil A McAuley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Australia
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Australia
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9
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Manero C. Experiences of Patients Adopting and Adapting to Closed-Loop Insulin Delivery Systems (CLIDS). Sci Diabetes Self Manag Care 2023; 49:46-54. [PMID: 36541406 DOI: 10.1177/26350106221144957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the study was to explore the perspectives and experiences of adults with type 1 diabetes (T1DM) who are currently using the closed-loop insulin delivery system (CLIDS). METHODS Eleven adults with T1DM who used closed-loop insulin pumps for at least 6 months participated in this qualitative descriptive study. RESULTS Four themes emerged from the rich descriptions: (1) striving for improvement, (2) missing a magic wand effect, (3) seeking support, and (4) barriers to adaptation. These themes represent both process-based and psychosocial implications for nursing practice and patient education. CONCLUSIONS To optimize CLIDS use and outcome, the antecedent conditions that contribute to patients' decision to adopt it must be understood. Then, interventions that focus on setting realistic expectations must be created. Patients need support as they incorporate CLIDS into their T1DM self-management. Training health care providers on the idiosyncrasies of adapting to CLIDS is critical. Patients must learn to relinquish control and trust the machine and manage the anxiety the system's intrusive alarms cause them so they can be better supported cognitively and psychosocially.
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Affiliation(s)
- Chrystina Manero
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts
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10
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Rankin D, Kimbell B, Hovorka R, Lawton J. Adolescents' and their parents' experiences of using a closed-loop system to manage type 1 diabetes in everyday life: qualitative study. Chronic Illn 2022; 18:742-756. [PMID: 33472409 PMCID: PMC9643806 DOI: 10.1177/1742395320985924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Type 1 diabetes can have life-shattering consequences for adolescents and parents. A closed-loop system is a cutting-edge technology which automatically regulates glucose to reduce the burden of diabetes management. We explored adolescents' and parents' experiences of using this technology to understand how it affects their biographies and everyday lives. METHODS In-depth interviews with 18 adolescents newly diagnosed with type 1 diabetes and 21 parents after ≥12 months experience using closed-loop technology. Data were analysed thematically. RESULTS Participants reported very few disruptions to their lives when using a closed-loop. Reports of family conflict were minimal as the closed-loop enabled dietary flexibility and glucose levels to be checked effortlessly. Adolescents described doing 'normal' activities without worrying about high/low glucose, and parents reported allowing them to do so unsupervised because the closed-loop would regulate their glucose and keep them safe. Some adolescents expressed concerns about the visibility of components and, to avoid stigma, described curtailing activities such as swimming. Participants described how the closed-loop enabled adolescents to be in control of, or create distance from, diabetes. DISCUSSION The closed-loop has life-enhancing consequences for both adolescents and parents and helps to reduce the biographical disruption of type 1 diabetes in this age group.
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Affiliation(s)
- D Rankin
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - B Kimbell
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R Hovorka
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - J Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
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11
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Ware J, Hovorka R. Closed-loop insulin delivery: update on the state of the field and emerging technologies. Expert Rev Med Devices 2022; 19:859-875. [PMID: 36331211 PMCID: PMC9780196 DOI: 10.1080/17434440.2022.2142556] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Over the last five years, closed-loop insulin delivery systems have transitioned from research-only to real-life use. A number of systems have been commercialized and are increasingly used in clinical practice. Given the rapidity of new developments in the field, understanding the capabilities and key similarities and differences of current systems can be challenging. This review aims to provide an update on the state of the field of closed-loop insulin delivery systems, including emerging technologies. AREAS COVERED We summarize key clinical safety and efficacy evidence of commercial and emerging insulin-only hybrid closed-loop systems for type 1 diabetes. A literature search was conducted and clinical trials using closed-loop systems during free-living conditions were identified to report on safety and efficacy data. We comment on emerging technologies and adjuncts for closed-loop systems, as well as non-technological priorities in closed-loop insulin delivery. EXPERT OPINION Commercial hybrid closed-loop insulin delivery systems are efficacious, consistently improving glycemic control when compared to standard therapy. Challenges remain in widespread adoption due to clinical inertia and the lack of resources to embrace technological developments by health care professionals.
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Affiliation(s)
- Julia Ware
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
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12
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Matejko B, Juza A, Kieć-Wilk B, Cyranka K, Krzyżowska S, Chen X, Cohen O, Da Silva J, Malecki MT, Klupa T. Transitioning of People With Type 1 Diabetes From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to MiniMed 780G Advanced Hybrid Closed-Loop System: A Two-Center, Randomized, Controlled Study. Diabetes Care 2022; 45:2628-2635. [PMID: 35972259 PMCID: PMC9862281 DOI: 10.2337/dc22-0470] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of transitioning to the MiniMed 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes mellitus (T1DM) naive to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) technologies. RESEARCH DESIGN AND METHODS This was a two-center, randomized, controlled, parallel-group trial with evaluation of individuals with T1DM aged 26-60 years managed with multiple daily injections (MDI) and self-monitoring of blood glucose (BGM) with HbA1c <10%. RESULTS A total of 41 participants were recruited and randomized to either the AHCL (n = 20) or the MDI+BGM (n = 21) group, and 37 participants (mean ± SD age 40.3 ± 8.0 years, duration of diabetes 17.3 ± 12.1 years, BMI 25.1 ± 3.1 kg/m2, HbA1c 7.2 ± 1.0%) completed the study. Time spent with glucose levels in target range increased from 69.3 ± 12.3% at baseline to 85.0 ± 6.3% at 3 months in the AHCL group, while remaining unchanged in the control group (treatment effect 21.5% [95% CI 15.7, 27.3]; P < 0.001). The time with levels below range (<70 mg/dL) decreased from 8.7 ± 7.3% to 2.1 ± 1.7% in the AHCL group and remained unchanged in the MDI+BGM group (treatment effect -4.4% [95% CI -7.4, -2.1]; P < 0.001). Participants from the AHCL group also had significant improvements in HbA1c levels (treatment effect -0.6% [95% CI -0.9, -0.2]; P = 0.005) and in quality of life (QoL) in specific subscales compared with the MDI+BGM group. CONCLUSIONS People with T1DM naive to CSII and CGM technologies initiating AHCL significantly and safely improved their glycemic control, as well as their QoL and psychological well-being.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland.,College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland.,Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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13
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Abstract
First envisioned by early diabetes clinicians, a person-centred approach to care was an aspirational goal that aimed to match insulin therapy to each individual's unique requirements. In the 100 years since the discovery of insulin, this goal has evolved to include personalised approaches to type 1 diabetes diagnosis, treatment, prevention and prediction. These advances have been facilitated by the recognition of type 1 diabetes as an autoimmune disease and by advances in our understanding of diabetes pathophysiology, genetics and natural history, which have occurred in parallel with advancements in insulin delivery, glucose monitoring and tools for self-management. In this review, we discuss how these personalised approaches have improved diabetes care and how improved understanding of pathogenesis and human biology might inform precision medicine in the future.
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Affiliation(s)
- Alice L J Carr
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
| | - Carmella Evans-Molina
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN, USA
- Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
- Herman B. Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
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14
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Roberts A, Fried L, Dart J, de Bock M, Fairchild J, King B, Ambler GR, Cameron F, McAuley SA, Keech AC, Jenkins A, O Neal DN, Davis EA, Jones TW, Abraham MB. Hybrid closed-loop therapy with a first-generation system increases confidence and independence in diabetes management in youth with type 1 diabetes. Diabet Med 2022; 39:e14907. [PMID: 35757899 DOI: 10.1111/dme.14907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
AIM Hybrid closed-loop (HCL) therapy improves glycaemic control in adolescents with type 1 diabetes; however, little is known about their lived experience using these systems. The aim of this study was to explore the lived experiences of youth with type 1 diabetes using HCL therapy, and their parents, to provide insight into their lived experiences. METHODS Adolescents and young adults aged 12-25 years, who used Medtronic MiniMed™ 670G HCL system during a 6-month randomised clinical trial, and their parents, were invited to participate in a semi-structured interview at the end of the study. Open-ended questions were used to explore the lived experiences of families using HCL. The interviews were audio-recorded, transcribed and analysed using thematic analysis to determine the main themes. RESULTS In all, 17 young people with type 1 diabetes mean ± SD age: 17.5 ± 4.2 years, diabetes duration: 11.0 ± 4.9 years and HbA1c 64 ± 9 mmol/mol (8.0 ± 0.8%) and 10 parents were interviewed. Three themes were identified: (1) 'Developing confidence and trust in the system', (2) 'Reduction in anxiety' and (3) 'Issues with device'. They reported a positive experience using HCL, with improvements in glucose levels and increased independence with diabetes management. However, frustration around the number of alarms and notifications associated with the system were also identified as issues. CONCLUSION Both youth and parents acknowledged the benefits of this first-generation HCL system in improving glycaemic outcomes and in providing flexibility and independence. These lived experiences provide valuable information in the introduction and provision of targeted education with HCL therapy.
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Affiliation(s)
- Alison Roberts
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Leanne Fried
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Julie Dart
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Martin de Bock
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Janice Fairchild
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, Australia
| | - Bruce King
- Department of Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, The University of Sydney, Sydney, Australia
| | - Fergus Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia
| | - Sybil A McAuley
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Anthony C Keech
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Alicia Jenkins
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David N O Neal
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Mary B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
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15
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Tanenbaum ML, Commissariat PV. Barriers and Facilitators to Diabetes Device Adoption for People with Type 1 Diabetes. Curr Diab Rep 2022; 22:291-299. [PMID: 35522355 PMCID: PMC9189072 DOI: 10.1007/s11892-022-01469-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Diabetes technology (insulin pumps, continuous glucose monitoring, automated insulin delivery systems) has advanced significantly and provides benefits to the user. This article reviews the current barriers to diabetes device adoption and sustained use, and outlines the known and potential facilitators for increasing and sustaining device adoption. RECENT FINDINGS Barriers to diabetes device adoption continue to exist at the system-, provider-, and individual-level. Known facilitators to promote sustained adoption include consistent insurance coverage, support for providers and clinics, structured education and support for technology users, and device user access to support as needed (e.g., through online resources). Systemic barriers to diabetes device adoption persist while growing evidence demonstrates the increasing benefits of newest devices and systems. There are ongoing efforts to develop evidence-based structured education programs to support device adoption and sustained use.
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Affiliation(s)
- Molly L Tanenbaum
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.
| | - Persis V Commissariat
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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16
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Nefs G. The Psychological Implications of Automated Insulin Delivery Systems in Type 1 Diabetes Care. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:846162. [PMID: 36992780 PMCID: PMC10012062 DOI: 10.3389/fcdhc.2022.846162] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/25/2022] [Indexed: 01/15/2023]
Abstract
Automated insulin delivery (AID) systems have brought important glycemic benefits to type 1 diabetes management. The present paper provides an overview of their psychological implications. Trials and real-world observational studies report improvements in diabetes-specific quality of life, with qualitative work describing reduced management burden, increased flexibility and improved relationships. Not all experiences are positive, however, evidenced by dropping algorithm use soon after device initiation. Apart from finance and logistics, reasons for discontinuation include technology frustrations, wear-related issues and unmet glycemic and work load expectations. New challenges include distrust in proper AID functioning, overreliance and deskilling, compensatory behaviors to override or trick the system and optimize time in range, and concerns related to wearing multiple devices on the body. Research efforts may focus on incorporating a diversity perspective, updating existing person-reported outcome measures according to new technology developments, addressing implicit or explicit health professional bias in technology access, examining the merits of incorporating stress reactivity in the AID algorithm, and developing concrete approaches for psychological counseling and support related to technology use. An open dialogue with health professionals and peers about expectations, preferences and needs may foster the collaboration between the person with diabetes and the AID system.
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Affiliation(s)
- Giesje Nefs
- Department of Medical Psychology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Diabeter, National Treatment and Research Center for Children, Adolescents and Adults With Type 1 Diabetes, Rotterdam, Netherlands
- Department of Medical and Clinical Psychology, Center of Research On Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, Tilburg, Netherlands
- *Correspondence: Giesje Nefs,
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17
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Tanenbaum ML, Ngo J, Hanes SJ, Basina M, Buckingham BA, Hessler D, Maahs DM, Mulvaney S, Hood KK. ONBOARD: A Feasibility Study of a Telehealth-Based Continuous Glucose Monitoring Adoption Intervention for Adults with Type 1 Diabetes. Diabetes Technol Ther 2021; 23:818-827. [PMID: 34270351 PMCID: PMC8819504 DOI: 10.1089/dia.2021.0198] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: Continuous glucose monitoring (CGM) can improve glycemic control for adults with type 1 diabetes (T1D) but certain barriers interfere with consistent use including cost, data overload, alarm fatigue, physical discomfort, and unwanted social attention. This pilot study aimed to examine feasibility and acceptability of a behavioral intervention, ONBOARD (Overcoming Barriers and Obstacles to Adopting Diabetes Devices) to support adults with T1D in optimizing CGM use. Methods: Adults (18-50 years) with T1D in their first year of CGM use were invited to participate in a tailored, multicomponent telehealth-based intervention delivered over four 60-min sessions every 2-3 weeks. Participants completed surveys (demographics; diabetes distress, Diabetes Distress Scale for adults with type 1 diabetes; satisfaction with program) and provided CGM data at baseline and postintervention (3 months). Data were analyzed using paired t-tests and Wilcoxon signed-rank tests. Results: Twenty-two participants (age = 30.95 ± 8.32 years; 59% women; 91% non-Hispanic; 86% White, 5% Black, 9% other; 73% pump users) completed the study. ONBOARD demonstrated acceptability and a high rate of retention. Moderate effect sizes were found for reductions in diabetes distress (P = 0.01, r = -0.37) and increases in daytime spent in target range (70-180 mg/dL: P = 0.03, r = -0.35). There were no significant increases in hypoglycemia. Conclusions: Findings show preliminary evidence of feasibility, acceptability, and efficacy of ONBOARD for supporting adults with T1D in optimizing CGM use while alleviating diabetes distress. Further research is needed to examine ONBOARD in a larger sample over a longer period.
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Affiliation(s)
- Molly L. Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
- Address correspondence to: Molly L. Tanenbaum, PhD, Center for Academic Medicine, Division of Endocrinology and Diabetes, MC 5660, Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Road, Palo Alto, CA 94304-5660, USA
| | - Jessica Ngo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah J. Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Marina Basina
- Stanford Diabetes Research Center, Stanford, California, USA
- Division of Endocrinology, Gerontology and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Bruce A. Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - David M. Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Shelagh Mulvaney
- Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Korey K. Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
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18
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Tanenbaum ML, Messer LH, Wu CA, Basina M, Buckingham BA, Hessler D, Mulvaney SA, Maahs DM, Hood KK. Help when you need it: Perspectives of adults with T1D on the support and training they would have wanted when starting CGM. Diabetes Res Clin Pract 2021; 180:109048. [PMID: 34534592 PMCID: PMC8578423 DOI: 10.1016/j.diabres.2021.109048] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 10/20/2022]
Abstract
AIMS The purpose of this study was to explore preferences that adults with type 1 diabetes (T1D) have for training and support to initiate and sustain optimal use of continuous glucose monitoring (CGM) technology. METHODS Twenty-two adults with T1D (M age 30.95 ± 8.32; 59.1% female; 90.9% Non-Hispanic; 86.4% White; diabetes duration 13.5 ± 8.42 years; 72.7% insulin pump users) who had initiated CGM use in the past year participated in focus groups exploring two overarching questions: (1) What helped you learn to use your CGM? and (2) What additional support would you have wanted? Focus groups used a semi-structured interview guide and were recorded, transcribed and analyzed. RESULTS Overarching themes identified were: (1) "I got it going by myself": CGM training left to the individual; (2) Internet as diabetes educator, troubleshooter, and peer support system; and (3) domains of support they wanted, including content and format of this support. CONCLUSION This study identifies current gaps in training and potential avenues for enhancing device education and CGM onboarding support for adults with T1D. Providing CGM users with relevant, timely resources and attending to the emotional side of using CGM could alleviate the burden of starting a new device and promote sustained device use.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
| | - Laurel H Messer
- University of Colorado Anschutz, Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA.
| | - Christine A Wu
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
| | - Marina Basina
- Stanford Diabetes Research Center, Stanford, CA, USA; Division of Endocrinology, Gerontology, & Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Bruce A Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
| | - Danielle Hessler
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Shelagh A Mulvaney
- Center for Diabetes Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA; School of Nursing, Vanderbilt University, Nashville, TN, USA.
| | - David M Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA.
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19
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Chalew S, Delamater AM, Washington S, Bhat J, Franz D, Gomez R, Felipe D, Tieh P, Finger L. Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes? J Diabetes Sci Technol 2021; 15:1069-1075. [PMID: 34137288 PMCID: PMC8442203 DOI: 10.1177/19322968211021386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.
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Affiliation(s)
- Stuart Chalew
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
- Stuart Chalew, MD, Department of
Pediatrics, Endocrinology and Diabetes, School of Medicine, Louisiana
State University Health Sciences Center, Children’s Hospital of New
Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA.
| | - Alan M. Delamater
- Department of Pediatrics,
University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonja Washington
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Jayalakshmi Bhat
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Diane Franz
- Department of Psychology, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Ricardo Gomez
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Dania Felipe
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Peter Tieh
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Laurie Finger
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
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20
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Rankin D, Kimbell B, Allen JM, Besser REJ, Boughton CK, Campbell F, Elleri D, Fuchs J, Ghatak A, Randell T, Thankamony A, Trevelyan N, Wilinska ME, Hovorka R, Lawton J. Adolescents' Experiences of Using a Smartphone Application Hosting a Closed-loop Algorithm to Manage Type 1 Diabetes in Everyday Life: Qualitative Study. J Diabetes Sci Technol 2021; 15:1042-1051. [PMID: 34261348 PMCID: PMC8411472 DOI: 10.1177/1932296821994201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Closed-loop technology may help address health disparities experienced by adolescents, who are more likely to have suboptimal glycemic control than other age groups and, because of their age, find diabetes self-management particularly challenging. The CamAPS FX closed-loop has sought to address accessibility and usability issues reported by users of previous prototype systems. It comprises small components and a smartphone app used to: announce meal-time boluses, adjust ("boost" or "ease-off") closed-loop insulin delivery, customize alarms, and review/share data. We explored how using the CamAPS FX platform influences adolescents' self-management practices and everyday lives. METHODS Eighteen adolescents were interviewed after having ≥6 months experience using the closed-loop platform. Data were analyzed thematically. RESULTS Participants reported feeling less burdened and shackled by diabetes because closed-loop components were easier to carry/wear, finger-pricks were not required, the smartphone app provided a discreet and less stigmatizing way of managing diabetes in public, and they were able to customize alarms. Participants also reported checking and reviewing data more regularly, because they did so when using the smartphone for other reasons. Some reported challenges in school settings where use of personal phones was restricted. Participants highlighted how self-management practices were improved because they could easily review glucose data and adjust closed-loop insulin delivery using the "boost" and "ease-off" functions. Some described how using the system resulted in them forgetting about diabetes and neglecting certain tasks. CONCLUSIONS A closed-loop system with small components and control algorithm on a smartphone app can enhance usability and acceptability for adolescents and may help address the health-related disparities experienced by this age group. However, challenges can arise from using a medical app on a device which doubles as a smartphone. TRIAL REGISTRATION Closed Loop From Onset in Type 1 Diabetes (CLOuD); NCT02871089; https://clinicaltrials.gov/ct2/show/NCT02871089.
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Affiliation(s)
- David Rankin
- Usher Institute, Medical School,
University of Edinburgh, UK
- David Rankin, PhD, Usher Institute,
University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Barbara Kimbell
- Usher Institute, Medical School,
University of Edinburgh, UK
| | - Janet M. Allen
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Rachel E. J. Besser
- NIHR Oxford Biomedical Research Centre,
Oxford University Hospitals NHS Foundation Trust, UK
- Department of Paediatrics, University of
Oxford, UK
| | - Charlotte K. Boughton
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
| | | | | | - Julia Fuchs
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Atrayee Ghatak
- Alder Hey Children’s NHS Foundation
Trust, Liverpool, UK
| | | | - Ajay Thankamony
- Addenbrookes Hospital, Cambridge
University Hospitals NHS Foundation Trust, UK
| | | | - Malgorzata E. Wilinska
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Roman Hovorka
- Wellcome Trust – Medical Research
Institute of Metabolic Science, University of Cambridge, UK
- Department of Paediatrics, University of
Cambridge, UK
| | - Julia Lawton
- Usher Institute, Medical School,
University of Edinburgh, UK
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21
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Schipp J, Skinner T, Holloway E, Scibilia R, Langstrup H, Speight J, Hendrieckx C. How Adults with Type 1 Diabetes Are Navigating the Challenges of Open-Source Artificial Pancreas Systems: A Qualitative Study. Diabetes Technol Ther 2021; 23:546-554. [PMID: 33720767 DOI: 10.1089/dia.2020.0652] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: An emerging group of people with type 1 diabetes are building and using their own artificial pancreas systems (APS). Currently, these "user-led," open-source systems are not endorsed by regulatory bodies. People face multiple challenges when building and using open-source APS (e.g., lacking required technical knowledge, difficulties sourcing hardware). We explored the experiences of adults with type 1 diabetes using open-source APS to understand how they are navigating these challenges. Research Design and Methods: We conducted semistructured telephone interviews (October 2018 to January 2019) with Australian adults about their experiences using an open-source APS. Interviews were recorded, transcribed, and analyzed thematically. Results: Participants included 23 adults with type 1 diabetes, aged 25-64 years, 10 (43%) women, with 1-34 months of experience of open-source APS. Participants used four key strategies to navigate challenges: (1) peer support, (2) self-sufficiency, (3) risk management, and (4) trade-offs. Participants relied on peer support and self-sufficiency to fill perceived gaps in professional and industry support. They felt that using an open-source solution was no riskier than previous management and demonstrated a conscious weighing-up of risks. Overall, participants felt that the experienced benefits for their physical health and quality of life outweighed the challenges and potential risks. Conclusions: Adults with type 1 diabetes are applying several interweaving psychosocial and practical strategies to navigate the challenges of building and using open-source APS. The findings highlight the importance of health professionals' showing support and understanding for those choosing to use an open-source APS.
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Affiliation(s)
- Jasmine Schipp
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Edith Holloway
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Renza Scibilia
- Diabetes Australia, Type 1 Diabetes and Communities, Canberra, Australia
| | - Henriette Langstrup
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
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22
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Ferrito L, Passanisi S, Bonfanti R, Cherubini V, Minuto N, Schiaffini R, Scaramuzza A. Efficacy of advanced hybrid closed loop systems for the management of type 1 diabetes in children. Minerva Pediatr (Torino) 2021; 73:474-485. [PMID: 34309344 DOI: 10.23736/s2724-5276.21.06531-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Over the last years significant advances have been achieved in the development of technologies for diabetes management. Continuous subcutaneous insulin infusion (CSII), continuous glucose monitoring (CGM), predictive low glucose management (PLGM), hybrid closed loop (HCL) and advanced hybrid closed loop (AHCL) systems allow better diabetes management, thus reducing the burden of the disease and the risk of chronic complications. This review summarizes the main characteristics of the currently available HCL and AHCL systems and their primary effects in children and adolescents with type 1 diabetes (T1D). The findings of trials assessing the glucose control (time in range, HbA1c values, hypoglycemic events), the health-related quality of life and the existing limits of the use of these technologies are reported. The most recent data clearly confirm the ability of the HCL and AHCL insulin delivery systems to safely achieve a significant improvement of glucose control and quality of life in the pediatric population with T1D. Further studies are underway to overcame current barriers and future improvements in the usability of these technologies are awaited to facilitate their use in the routine clinical practice. The HCL and AHCL algorithms are the key features of today's insulin delivery systems that mark a crucial step towards fully automated closed loop systems.
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Affiliation(s)
- Lucia Ferrito
- Division of Pediatrics and Neonatology, Senigallia Hospital, Senigallia, Ancona, Italy
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age, University of Messina, Messina, Italy
| | - Riccardo Bonfanti
- Diabetes Research Institute, Department of Pediatrics, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
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23
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Wang LR, Malcolm J, Arnaout A, Humphrey-Murto S, LaDonna KA. Real-World Patient Experience of Long-Term Hybrid Closed-Loop Insulin Pump Use. Can J Diabetes 2021; 45:750-756.e3. [PMID: 33958309 DOI: 10.1016/j.jcjd.2021.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Understanding of patient experiences and adaptations to hybrid closed-loop (HCL) pumps beyond the confines of short-term clinical trials is needed to inform best practices surrounding this emerging technology. We investigated long-term, real-world patient experiences with HCL technology. METHODS In semistructured interviews, 21 adults with type 1 diabetes at a single Canadian tertiary diabetes centre discussed their transition to use of Medtronic MiniMed 670G auto-mode. Interviews were audio-recorded, transcribed and analyzed iteratively to identify emerging themes. RESULTS Participants' mean age was 50±13 years, 12 of the 21 participants were female, baseline glycated hemoglobin (A1C) was 7.9±1.0% and auto-mode duration was 9.3±4.6 months. Three had discontinued auto-mode. Most participants praised auto-mode for reducing hypoglycemia, stabilizing glucose overnight and improving A1C, while also reporting frustration with frequency of alarms and user input, sensor quality and inadequate response to hyperglycemia. Participants with the highest baseline A1Cs (8.8% to 9.8%) tended to report immense satisfaction and trust in auto-mode, meeting their primary expectations of improved glycemic control. In contrast, participants with controlled diabetes (A1C <7.5%) had hoped to offload active management, but experienced significant cognitive and emotional labour associated with relinquishing control during suboptimal auto-mode performance. Participants were commonly aware of workarounds to "trick" the pump, and almost all participants with A1C <7.5% tried at least 1 workaround. CONCLUSIONS In the real-world setting, patients' goals and satisfaction with auto-mode appeared to vary considerably with their baseline diabetes control. Patients with the most suboptimal glycemic control described the greatest benefits and easiest adaptation process, challenging commonly held assumptions for patient selection for pump therapy.
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Affiliation(s)
- Linda R Wang
- Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Janine Malcolm
- Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amel Arnaout
- Division of Endocrinology and Metabolism, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Susan Humphrey-Murto
- Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kori A LaDonna
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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24
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Taleb N, Quintal A, Rakheja R, Messier V, Legault L, Racine E, Rabasa-Lhoret R. Perceptions and expectations of adults with type 1 diabetes for the use of artificial pancreas systems with and without glucagon addition: Results of an online survey. Nutr Metab Cardiovasc Dis 2021; 31:658-665. [PMID: 33358714 PMCID: PMC7886941 DOI: 10.1016/j.numecd.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/28/2020] [Accepted: 10/07/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The first hybrid artificial pancreas (AP) systems with insulin only (mono-hormonal) have recently reached the market while next generations systems are under development including those with glucagon addition (bi-hormonal). Understanding the expectations and impressions of future potential users about AP systems is important for optimal use of this clinically effective emerging technology. METHODS AND RESULTS An online survey about AP systems which consisted of 50 questions was addressed to people with type 1 diabetes in the province of Quebec, Canada. Surveys were completed by 123 respondents with type 1 diabetes (54% women, mean (SD) age 40.2 (14.4) y.o., diabetes duration 23.7 (14.1) years, 58% insulin pump users and 43% glucose sensor users). Of the respondents, 91% understood how AP systems work, 79% trusted them with correct insulin dosing, 73% were willing to replace their current treatment with AP and 80% expected improvement in quality of life. Anxiety about letting an algorithm control their glucose levels was expressed by 18% while the option of ignoring or modifying AP instructions was favoured by 88%. As for bi-hormonal AP systems, 83% of respondents thought they would be useful to further reduce hypoglycemic risks. CONCLUSIONS Overall, respondents expressed positive views about AP systems use and high expectations for a better quality of life, glycemic control and hypoglycemia reduction. Data from this survey could be useful to health care professionals and developers of AP systems.
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Affiliation(s)
- Nadine Taleb
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, 2900, Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Ariane Quintal
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada
| | - Rohan Rakheja
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada
| | - Virginie Messier
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada
| | - Laurent Legault
- Division of Endocrinology, McGill University, 1001 Decarie Blvd., Montreal, Quebec, H4A 1J4, Canada
| | - Eric Racine
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada; Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, QC, H3A 2B4, Canada; Experimental Medicine, McGill University, 1001 Décarie Blvd., Montreal, QC, H4A 1J4, Canada; Biomedical Ethics Unit, McGill University, 3647 Peel, Montréal, QC, H3A 1X1, Canada; Départment de Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd., Montreal, QC, H3T 1J4, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, 110, avenue des Pins Ouest, Montreal, QC, H2W 1R7, Canada; Experimental Medicine, McGill University, 1001 Décarie Blvd., Montreal, QC, H4A 1J4, Canada; Départment de Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd., Montreal, QC, H3T 1J4, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, 2405 chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1A8, Canada; Montreal Diabetes Research Center & Endocrinology Division, 900 Saint-Denis, Montréal, QC, H2X 0A9, Canada.
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25
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Glucose Control During Physical Activity and Exercise Using Closed Loop Technology in Adults and Adolescents with Type 1 Diabetes. Can J Diabetes 2020; 44:740-749. [DOI: 10.1016/j.jcjd.2020.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
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26
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Quintal A, Messier V, Rabasa-Lhoret R, Racine E. A qualitative study exploring the expectations of people living with type 1 diabetes regarding prospective use of a hybrid closed-loop system. Diabet Med 2020; 37:1832-1840. [PMID: 32298490 PMCID: PMC8232376 DOI: 10.1111/dme.14309] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 01/09/2023]
Abstract
AIM To identify the expectations of a diversified sample of informed adults with type 1 diabetes on their prospective use of a hybrid closed-loop system. METHODS Semi-structured interviews were conducted with 16 adults with type 1 diabetes who shared their expectations on an experimental hybrid closed-loop system after receiving information on its design, functioning and capability. The sample had equal representation of genders and diabetes management methods and was diversified according to age, education and occupation when possible. Qualitative content analysis of the interview transcripts with MaxQDA was used to identify expected benefits, expected inconveniences and concerns, expected improvements to design and functionalities, and interest and trust in the system. RESULTS Participants expected benefits regarding diabetes management, clinical outcomes, psychosocial aspects of their lives, nutrition and meals, and physical activity. Participants expected inconveniences or shared concerns regarding wearability, costs and technical limitations. According to participants, improvements could be made to the system's physical appearance, practical convenience, functionalities, and software integration. Overall, 12 participants would use the system. While participants' trust could be immediate or grow over time, it could ultimately be conditional on the system's performance. CONCLUSION Prospective users' general enthusiasm and trust foster the clinical and commercial success of hybrid closed-loop systems. However, poor user satisfaction caused by unrealistic expectations and plausible inconveniences and concerns may limit this success. Providing prospective users with comprehensive information while validating their understanding could mitigate unrealistic expectations. Improvements to design and coverage policies could favour uptake.
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Affiliation(s)
- A Quintal
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
- Département de Médecine Sociale et Préventive, University of Montréal, Montreal, QC, Canada
| | - V Messier
- Metabolic Diseases Research Unit and Diabetes Clinic, Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
| | - R Rabasa-Lhoret
- Metabolic Diseases Research Unit and Diabetes Clinic, Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
- Department of Nutrition, University of Montréal, Montreal, QC, Canada
- Montreal Diabetes Research Centre and Endocrinology Division, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Medicine, University of Montréal, Montréal, QC, Canada
| | - E Racine
- Pragmatic Health Ethics Research Unit, Institut de Recherches Cliniques de Montréal, Montreal, QC, Canada
- Département de Médecine Sociale et Préventive, University of Montréal, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
- Experimental Medicine and Biomedical Ethics Unit, McGill University, Montreal, QC, Canada
- Department of Medicine, University of Montréal, Montréal, QC, Canada
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27
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Lawton J, Kimbell B, Rankin D, Ashcroft NL, Varghese L, Allen JM, Boughton CK, Campbell F, Randell T, Besser REJ, Trevelyan N, Hovorka R. Health professionals' views about who would benefit from using a closed-loop system: a qualitative study. Diabet Med 2020; 37:1030-1037. [PMID: 31989684 DOI: 10.1111/dme.14252] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 12/19/2022]
Abstract
AIM To explore health professionals' views about who would benefit from using a closed-loop system and who should be prioritized for access to the technology in routine clinical care. METHODS Health professionals (n = 22) delivering the Closed Loop from Onset in type 1 Diabetes (CLOuD) trial were interviewed after they had ≥ 6 months' experience supporting participants using a closed-loop system. Data were analysed thematically. RESULTS Interviewees described holding strong assumptions about the types of people who would use the technology effectively prior to the trial. Interviewees described changing their views as a result of observing individuals engaging with the closed-loop system in ways they had not anticipated. This included educated, technologically competent individuals who over-interacted with the system in ways which could compromise glycaemic control. Other individuals, who health professionals assumed would struggle to understand and use the technology, were reported to have benefitted from it because they stood back and allowed the system to operate without interference. Interviewees concluded that individual, family and psychological attributes cannot be used as pre-selection criteria and, ideally, all individuals should be given the chance to try the technology. However, it was recognized that clinical guidelines will be needed to inform difficult decisions about treatment allocation (and withdrawal), with young children and infants being considered priority groups. CONCLUSIONS To ensure fair and equitable access to closed-loop systems, prejudicial assumptions held by health professionals may need to be addressed. To support their decision-making, clinical guidelines need to be made available in a timely manner.
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Affiliation(s)
- J Lawton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - B Kimbell
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - D Rankin
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - N L Ashcroft
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - L Varghese
- Cambridge Clinical Trials Unit, Cambridge, UK
| | - J M Allen
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - C K Boughton
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | | | - T Randell
- Nottingham Children's Hospital, Nottingham, UK
| | - R E J Besser
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - N Trevelyan
- Southampton Children's Hospital, Southampton, UK
| | - R Hovorka
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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28
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Kimbell B, Rankin D, Ashcroft NL, Varghese L, Allen JM, Boughton CK, Campbell F, Ghatak A, Randell T, Besser RE, Trevelyan N, Hovorka R, Lawton J. What Training, Support, and Resourcing Do Health Professionals Need to Support People Using a Closed-Loop System? A Qualitative Interview Study with Health Professionals Involved in the Closed Loop from Onset in Type 1 Diabetes (CLOuD) Trial. Diabetes Technol Ther 2020; 22:468-475. [PMID: 32048877 PMCID: PMC7262645 DOI: 10.1089/dia.2019.0466] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: We explored health professionals' views about the training, support, and resourcing needed to support people using closed-loop technology in routine clinical care to help inform the development of formal guidance. Methods: Interviews were conducted with health professionals (n = 22) delivering the Closed Loop from Onset in Type 1 Diabetes (CLOuD) trial after they had ≥6 months' experience of supporting participants using a closed-loop system. Data were analyzed descriptively. Results: Interviewees described how, compared with other insulin regimens, teaching and supporting individuals to use a closed-loop system could be initially more time-consuming. However, they also noted that after an initial adjustment period, users had less need for initiating contact with the clinical team compared with people using pumps or multiple daily injections. Interviewees highlighted how a lessened need for ad hoc clinical input could result in new challenges; specifically, they had fewer opportunities to reinforce users' diabetes knowledge and skills and detect potential psychosocial problems. They also observed heightened anxiety among some parents due to the constant availability of data and unrealistic expectations about the system's capabilities. Interviewees noted that all local diabetes teams should be empowered to deliver closed-loop system care, but stressed that health professionals supporting closed-loop users in routine care will need comprehensive technology training and standardized clinical guidance. Conclusion: These findings constitute an important starting point for the development of formal guidance to support the rollout of closed-loop technology. Our recommendations, if actioned, will help limit the potential additional burden of introducing closed-loop systems in routine clinical care and help inform appropriate user education and support.
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Affiliation(s)
- Barbara Kimbell
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
- Address correspondence to: Barbara Kimbell, BSc (Hons), MSc, PhD, Usher Institute, Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, United Kingdom
| | - David Rankin
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicole L. Ashcroft
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | | | - Janet M. Allen
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Charlotte K. Boughton
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | | | - Atrayee Ghatak
- Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Rachel E.J. Besser
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | | | - Roman Hovorka
- Wellcome Trust–Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Julia Lawton
- Usher Institute, Medical School, University of Edinburgh, Edinburgh, United Kingdom
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29
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Manning ML, Singh H, Stoner K, Habif S. The Development and Psychometric Validation of the Diabetes Impact and Device Satisfaction Scale for Individuals with Type 1 Diabetes. J Diabetes Sci Technol 2020; 14:309-317. [PMID: 32028790 PMCID: PMC7196859 DOI: 10.1177/1932296819897976] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND With the rapid development of new insulin delivery technology, measuring patient experience has become especially pertinent. The current study reports on item development, psychometric validation, and intended use of the newly developed Diabetes Impact and Device Satisfaction (DIDS) Scale. METHOD The DIDS Scale was informed by a comprehensive literature review, and field tested as part of two focus groups. The finalized measure was used at baseline and 6 months post-assessment with a large US cohort. Exploratory factor analyses (EFAs) were conducted to determine and confirm factor structure and item selection. Internal reliability, test-retest reliability, and convergent/divergent validity of the emerged factors were tested with demographics, diabetes-specific information, and diabetes behavioral and satisfaction measures. RESULTS In all, 778 participants with type 1 diabetes (66% female, mean age 47.13 ± 17.76 years, 74% insulin pump users) completed surveys at both baseline and post-assessment. EFA highlighted two factors-Device Satisfaction (seven items, Cronbach's α = 0.85-0.90) and Diabetes Impact (four items, Cronbach's α = 0.71-0.75). DIDS Scale demonstrated good concurrent validity and test-retest reliability. CONCLUSION The DIDS Scale is a novel and a brief assessment tool with robust psychometric properties. It is recommended for use across all insulin delivery devices and is considered appropriate for use in longitudinal studies. Future studies are recommended to evaluate the performance of DIDS Scale in diverse populations with diabetes.
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Affiliation(s)
| | | | | | - Steph Habif
- Tandem Diabetes Care, San Diego, CA,
USA
- Steph Habif, EdD, MS, Tandem Diabetes Care,
10935 Vista Sorrento Pkwy, San Diego, CA 92121, USA.
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Lal RA, Ekhlaspour L, Hood K, Buckingham B. Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes. Endocr Rev 2019; 40:1521-1546. [PMID: 31276160 PMCID: PMC6821212 DOI: 10.1210/er.2018-00174] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
Recent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an "artificial pancreas" that is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short-term and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep, and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems use a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin that has already been delivered to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day, alleviating meal announcements, carbohydrate counting, alerts, and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with the closed-loop system.
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Affiliation(s)
- Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Laya Ekhlaspour
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Korey Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Bruce Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Hilliard ME, Levy W, Anderson BJ, Whitehouse AL, Commissariat PV, Harrington KR, Laffel LM, Miller KM, Van Name M, Tamborlane WV, DeSalvo DJ, DiMeglio LA. Benefits and Barriers of Continuous Glucose Monitoring in Young Children with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:493-498. [PMID: 31287721 PMCID: PMC6708264 DOI: 10.1089/dia.2019.0142] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Continuous glucose monitoring (CGM) has potential to address challenges of type 1 diabetes (T1D) management for young children. CGM use is increasing, yet remains underutilized. Characterizing parents' experiences with CGM can inform clinical strategies to help parents make decisions about diabetes management, overcome obstacles to initiating and sustaining CGM use, and maximize benefits of CGM use in their children's diabetes care. Methods: Transcripts from semistructured qualitative interviews with 55 parents of children aged 1 to <8 years, with T1D duration ≥6 months, and whose child currently or previously used CGM were coded and analyzed to derive themes about their experiences with CGM. Results: Participants were 88% mothers and the mean child age was 5.0 ± 1.5 years. Parents described benefits of CGM use: decreased worry about glucose excursions, improved sleep, increased sense of safety with children who cannot recognize or express symptoms of hypo- or hyperglycemia, and greater comfort with other caregivers, especially using remote monitoring functionality when away from children. Challenges included painful insertions, wearing multiple devices on small bodies, disruptive alerts, data gaps due to lost signals, skin/adhesive problems, and difficulty interpreting the amount of information generated by CGM. For some, the challenges outweighed potential benefits and they stopped CGM use. Conclusions: CGM may address unique challenges of T1D in young children and increase parental comfort with diabetes management, yet there are multiple barriers to initiating or maintaining CGM use. Education and behavioral support to address these benefits and barriers may equip caregivers with skills to address challenges of CGM use.
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Affiliation(s)
- Marisa E. Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Wendy Levy
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Barbara J. Anderson
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | | | | | | | | | | | | | | | - Daniel J. DeSalvo
- Texas Children's Hospital and Baylor College of Medicine, Department of Pediatrics, Houston, Texas
| | - Linda A. DiMeglio
- Indiana University School of Medicine, Pediatric Endocrinology/Diabetology, Indianapolis, IN
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Wildevuur SE, Simonse LW, Groenewegen P, Klink A. Information and communication technology enabling partnership in person-centred diabetes management: building a theoretical framework from an inductive case study in The Netherlands. BMJ Open 2019; 9:e025930. [PMID: 31209085 PMCID: PMC6589019 DOI: 10.1136/bmjopen-2018-025930] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 05/25/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The aim of this paper is to construct a theoretical framework for information and communication technology (ICT)-enabled partnership towards diabetes management. DESIGN We conducted an inductive case study and held interviews on the development and use of an artificial pancreas (AP) system for diabetes management. SETTING The study was carried out in the Netherlands with users of an AP system. PARTICIPANTS We interviewed six patients with type 1 diabetes, five healthcare professionals (two medical specialists and three diabetes nurses), and one policy advisor from the Ministry of Health, Welfare and Sport. RESULTS We built a new theoretical framework for ICT-enabled person-centred diabetes management, covering the central themes of self-managing the disease, shared analysing of (medical) data and experiencing the partnership. We found that ICT yielded new activities of data sharing and a new role for data professionals in the provision of care as well as contributed to carefree living thanks to the semiautomated management enabled by the device. Our data suggested that to enable the partnership through ICT, organisational adjustments need to be made such as the development of new ICT services and a viable financial model to support these services. CONCLUSION The management of diabetes through ICT requires an adjustment of the partnership between persons with the chronic condition and the healthcare professional(s) in such a way that the potential for self-managing the condition by analysing the newly available (medical) data (from the AP system) together leads to an experience of partnership between patients and healthcare professionals.
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Affiliation(s)
- Sabine E Wildevuur
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Waag | technology & society - Care, Amsterdam, The Netherlands
| | | | | | - Ab Klink
- Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lawton J, Blackburn M, Rankin D, Allen J, Campbell F, Leelarathna L, Tauschmann M, Thabit H, Wilinska ME, Hovorka R. The impact of using a closed-loop system on food choices and eating practices among people with Type 1 diabetes: a qualitative study involving adults, teenagers and parents. Diabet Med 2019; 36:753-760. [PMID: 30575114 PMCID: PMC6510609 DOI: 10.1111/dme.13887] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 01/11/2023]
Abstract
AIMS We explored whether, how and why moving onto and using a hybrid day-and-night closed-loop system affected people's food choices and dietary practices to better understand the impact of this technology on everyday life and inform recommendations for training and support given to future users. METHODS Twenty-four adults, adolescents and parents were interviewed before commencing use of the closed-loop system and following its 3-month use. Data were analysed thematically and longitudinally. RESULTS While participants described preparing and/or eating similar meals to those consumed prior to using a closed-loop, many described feeling more normal and less burdened by diabetes in dietary situations. Individuals also noted how the use of this technology could lead to deskilling (less precise carbohydrate counting) and less healthy eating (increased snacking and portion sizes and consumption of fatty, energy-dense foods) because of the perceived ability of the system to deal with errors in carbohydrate counting and address small rises in blood glucose without a corrective dose needing to be administered. CONCLUSIONS While there may be quality-of-life benefits to using a closed-loop, individuals might benefit from additional nutritional and behavioural education to help promote healthy eating. Refresher training in carbohydrate counting may also be necessary to help ensure that users are able to undertake diabetes management in situations where the technology might fail or that they take a break from using it.
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Affiliation(s)
- J. Lawton
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - M. Blackburn
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - D. Rankin
- Usher Institute of Population Health Sciences and InformaticsUniversity of EdinburghEdinburghUK
| | - J. Allen
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | - L. Leelarathna
- Manchester Diabetes CentreManchester University NHS Foundation Trust and University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - M. Tauschmann
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - H. Thabit
- Manchester Diabetes CentreManchester University NHS Foundation Trust and University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - M. E. Wilinska
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - R. Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
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Lawton J, Blackburn M, Rankin D, Allen JM, Campbell FM, Leelarathna L, Tauschmann M, Thabit H, Wilinska ME, Elleri D, Hovorka R. Participants' Experiences of, and Views About, Daytime Use of a Day-and-Night Hybrid Closed-Loop System in Real Life Settings: Longitudinal Qualitative Study. Diabetes Technol Ther 2019; 21:119-127. [PMID: 30720338 PMCID: PMC6434584 DOI: 10.1089/dia.2018.0306] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore individuals' experiences of daytime use of a day-and-night hybrid closed-loop system, their information and support needs, and their views about how future systems could be improved. RESEARCH DESIGN AND METHODS Twenty-four adults, adolescents, and parents were interviewed before using a hybrid day-and-night closed-loop system and 3 months later, data were analyzed thematically. RESULTS Participants praised the closed loop's ability to respond to high and low blood glucose in ways which extended beyond their own capabilities and to act as a safety net and mop up errors, such as when a mealtime bolus was forgotten or unplanned activity was undertaken. Participants also described feeling less burdened by diabetes as a consequence and more able to lead flexible, spontaneous lives. Contrary to their initial expectations, and after trust in the system had been established, most individuals wanted opportunities to collaborate with the closed loop to optimize its effectiveness. Such individuals expressed a need to communicate information, such as when routines changed or to indicate different intensities of physical activity. While individuals valued frequent contact with staff in the initial month of use, most felt that their long-term support needs would be no greater than when using an insulin pump. CONCLUSIONS While participants reported substantial benefits to using the closed loop during the day, they also identified ways in which the technology could be refined and education and training tailored to optimize effective use. Our findings suggest that mainstreaming this technology will not necessarily lead to increased demands on clinical staff.
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Affiliation(s)
- Julia Lawton
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
- Address correspondence to: Julia Lawton, PhD, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Edinburgh EH8 9AG, United Kingdom
| | - Maxine Blackburn
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - David Rankin
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Janet M. Allen
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | | | - Lalantha Leelarathna
- Manchester Diabetes Center, Manchester Academic Health Science Center, Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Martin Tauschmann
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Hood Thabit
- Manchester Diabetes Center, Manchester Academic Health Science Center, Manchester University NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Malgorzata E. Wilinska
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Daniela Elleri
- Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Roman Hovorka
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
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Tanenbaum ML, Adams RN, Iturralde E, Hanes SJ, Barley RC, Naranjo D, Hood KK. From Wary Wearers to d-Embracers: Personas of Readiness to Use Diabetes Devices. J Diabetes Sci Technol 2018; 12:1101-1107. [PMID: 30132692 PMCID: PMC6232751 DOI: 10.1177/1932296818793756] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diabetes devices such as insulin pumps and continuous glucose monitoring (CGM) are associated with improved health and quality of life in adults with type 1 diabetes (T1D). However, uptake remains low. The aim of this study was to develop different "personas" of adults with T1D in relation to readiness to adopt new diabetes technology. METHODS Participants were 1498 T1D Exchange participants who completed surveys on barriers to uptake, technology attitudes, and other psychosocial variables. HbA1c data was available from the T1D Exchange for 30% of the sample. K-means cluster analyses grouped the sample by device barriers and attitudes. The authors assigned descriptive labels based on cluster characteristics. ANOVAs and chi-square tests assessed group differences by demographic and psychosocial variables (eg, diabetes duration, diabetes distress). RESULTS Analyses yielded five distinct personas. The d-Embracers (54% of participants) endorsed few barriers to device use and had the highest rates of device use, lowest HbA1c, and were the least distressed. The Free Rangers (23%) had the most negative technology attitudes. The Data Minimalists (10%) used pumps but had lower CGM use and did not want more diabetes information. The Wary Wearers (11%) had lower overall device use, were younger, more distressed, endorsed many barriers, and had higher HbA1c. The High Distress (3%) group members were the youngest, had the shortest diabetes duration, reported the most barriers, and were the most distressed. CONCLUSION These clinically meaningful personas of device readiness can inform tailored interventions targeting barriers and psychosocial needs to increase device uptake.
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Affiliation(s)
- Molly L. Tanenbaum
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Rebecca N. Adams
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Esti Iturralde
- Division of Research, Kaiser Permanente
Northern California, Oakland, CA, USA
| | - Sarah J. Hanes
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Regan C. Barley
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Diana Naranjo
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA
| | - Korey K. Hood
- Department of Pediatrics, Stanford
University School of Medicine, Palo Alto, CA, USA
- Korey K. Hood, PhD, Department of
Pediatrics, Stanford University School of Medicine, 780 Welch Rd., Palo Alto, CA
94304, USA.
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36
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Feige T. Do-it-yourself Artificial Pancreas – Technologiehype oder realer Nutzen? DIABETOLOGE 2018. [DOI: 10.1007/s11428-018-0402-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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37
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Peters AL, Ahmann AJ, Hirsch IB, Raymond JK. Advances in Glucose Monitoring and Automated Insulin Delivery: Supplement to Endocrine Society Clinical Practice Guidelines. J Endocr Soc 2018; 2:1214-1225. [PMID: 30324178 PMCID: PMC6179160 DOI: 10.1210/js.2018-00262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 12/22/2022] Open
Abstract
Endocrine Society guideline recommendations on diabetes technology in adults originate from the 2016 guideline titled “Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline.” Society recommendations on diabetes technology in children are contained in the 2011 guideline titled “Continuous Glucose Monitoring: An Endocrine Society Clinical Practice Guideline.” The field of diabetes technology is a rapidly advancing one, with new devices released annually and data from clinical trials published frequently. This report describes the most recent findings since the 2011 and 2016 guidelines were written, combining summaries of new literature with the authors’ clinical experience of new devices. Although we describe what we believe to be important scientific and technological updates since these guidelines were published, we are not advancing formal additions or amendments to previously offered recommendations.
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Affiliation(s)
- Anne L Peters
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Andrew J Ahmann
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, Oregon
| | - Irl B Hirsch
- Endocrine and Diabetes Care Center, University of Washington Medical Center, Seattle, Washington
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
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Adams RN, Tanenbaum ML, Hanes SJ, Ambrosino JM, Ly TT, Maahs DM, Naranjo D, Walders-Abramson N, Weinzimer SA, Buckingham BA, Hood KK. Psychosocial and Human Factors During a Trial of a Hybrid Closed Loop System for Type 1 Diabetes Management. Diabetes Technol Ther 2018; 20:648-653. [PMID: 30239219 DOI: 10.1089/dia.2018.0174] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hybrid closed loop (HCL) systems are designed to automate insulin delivery to improve type 1 diabetes (T1D) outcomes and reduce user burden and distress. Because the systems only automate some aspects of diabetes care, psychosocial and human factors remain an important consideration in their use. Thus, we examined whether psychosocial and human factors (i.e., distress related to diabetes management, fear of hypoglycemia, and technology attitudes) would (1) change after using the system and (2) predict glycemic outcomes during the trial. SUBJECTS AND METHODS Fourteen adults and 15 adolescents with T1D participated in a multisite clinical trial of an investigational version of the MiniMed™ 670G system (Medtronic, Northridge, CA) over 4 to 5 days in a semisupervised outpatient setting. Users completed surveys assessing psychosocial and human factors before beginning the HCL system and at the conclusion of the study. t-Tests and regression analyses were conducted to examine whether these factors changed following trial exposure to the HCL system and predicted glycemic outcomes during the trial. RESULTS Diabetes management distress decreased and diabetes technology attitudes became more positive over the trial period. Fear of hypoglycemia did not change over the trial period. There was a trend toward greater pretrial management distress predicting less time in range during the trial, controlling for time in range before the trial. CONCLUSIONS Results suggest that this system is promising for enhancing technology attitudes and reducing management distress. Psychosocial factors, such as management distress, may negatively impact glycemic outcomes and should be a priority area for further investigation.
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Affiliation(s)
- Rebecca N Adams
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
| | - Molly L Tanenbaum
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
| | - Sarah J Hanes
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
| | | | - Trang T Ly
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
- 3 School of Paediatrics and Child Health, The University of Western Australia , Crawley, Western Australia
| | - David M Maahs
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
| | - Diana Naranjo
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
| | | | | | - Bruce A Buckingham
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
| | - Korey K Hood
- 1 Department of Pediatrics, Stanford University School of Medicine , Palo Alto, California
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Prahalad P, Tanenbaum M, Hood K, Maahs DM. Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes. Diabet Med 2018; 35:419-429. [PMID: 29356074 DOI: 10.1111/dme.13588] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/09/2023]
Abstract
With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life.
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Affiliation(s)
- P Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - M Tanenbaum
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - K Hood
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - D M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
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