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Søholm U, Holmes-Truscott E, Broadley M, Amiel SA, Hendrieckx C, Choudhary P, Pouwer F, Shaw JAM, Speight J. Hypoglycaemia symptom frequency, severity, burden, and utility among adults with type 1 diabetes and impaired awareness of hypoglycaemia: Baseline and 24-week findings from the HypoCOMPaSS study. Diabet Med 2024; 41:e15231. [PMID: 37746767 DOI: 10.1111/dme.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/26/2023]
Abstract
AIMS To determine the frequency, severity, burden, and utility of hypoglycaemia symptoms among adults with type 1 diabetes (T1D) and impaired awareness of hypoglycaemia (IAH) at baseline and week 24 following the HypoCOMPaSS awareness restoration intervention. METHODS Adults (N = 96) with T1D (duration: 29 ± 12 years; 64% women) and IAH completed the Hypoglycaemia Burden Questionnaire (HypoB-Q), assessing experience of 20 pre-specified hypoglycaemia symptoms, at baseline and week 24. RESULTS At baseline, 93 (97%) participants experienced at least one symptom (mean ± SD 10.6 ± 4.6 symptoms). The proportion recognising each specific symptom ranged from 15% to 83%. At 24 weeks, symptom severity and burden appear reduced, and utility increased. CONCLUSIONS Adults with T1D and IAH experience a range of hypoglycaemia symptoms. Perceptions of symptom burden or utility are malleable. Although larger scale studies are needed to confirm, these findings suggest that changing the salience of the symptomatic response may be more important in recovering protection from hypoglycaemia through regained awareness than intensifying symptom frequency or severity.
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Affiliation(s)
- Uffe Søholm
- Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Søborg, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Diabetes, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elizabeth Holmes-Truscott
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Institute for Health Transformations, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Institute for Health Transformations, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Pratik Choudhary
- Department of Diabetes, School of Cardiovascular Medicine and Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - James A M Shaw
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia
- School of Psychology, Institute for Health Transformations, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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2
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Tanenbaum ML, Commissariat PV. Experience with burdens of diabetes device use that affect uptake and optimal use in people with type 1 diabetes. Endocr Connect 2023; 12:e230193. [PMID: 37522857 PMCID: PMC10503226 DOI: 10.1530/ec-23-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 08/01/2023]
Abstract
Diabetes technology continues to advance, with more individuals with type 1 diabetes (T1D) adopting insulin pumps, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems that integrate real-time glucose data with an algorithm to assist with insulin dosing decisions. These technologies are linked with benefits to glycemic outcomes (e.g. increased time in target range), diabetes management behaviors, and quality of life. However, current devices and systems are not without barriers and hassles for the user. The intent of this review is to describe the personal challenges and reactions that users experience when interacting with current diabetes technologies, which can affect their acceptance and motivation to engage with their devices. This review will discuss user experiences and strategies to address three main areas: (i) the emotional burden of utilizing a wearable device; (ii) the perceived and experienced negative social consequences of device use; and (iii) the practical challenges of wearing devices.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Persis V Commissariat
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
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3
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Messina R, Liliana I, Iommi M, Trombetta M, Roos T, Hermanns N, Di Sipio A, Fantini MP, Calvo V. Assessing attitudes towards insulin pump therapy in adults with type 1 diabetes: Italian validation of the Insulin Pump Attitudes Questionnaire (IT-IPA questionnaire). Acta Diabetol 2023; 60:687-695. [PMID: 36801976 PMCID: PMC10063466 DOI: 10.1007/s00592-023-02046-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Abstract
AIMS The aim of the study was to adapt the German version of the insulin pump therapy (IPA) questionnaire to Italian (IT-IPA) and to evaluate its psychometric properties in adults with type 1 diabetes. METHODS We conducted a cross-sectional study, data were collected through an online survey. In addition to IT-IPA, questionnaires evaluating depression, anxiety, diabetes distress, self-efficacy, and treatment satisfaction were administered. The six factors identified in the IPA German version were assessed using confirmatory factor analysis; psychometric testing included construct validity and internal consistency. RESULTS The online survey was compiled by 182 individuals with type 1 diabetes: 45.6% continuous subcutaneous insulin infusion (CSII) users and 54.4% multiple daily insulin injection users. The six-factor model had a very good fit in our sample. The internal consistency was acceptable (Cronbach's α = 0.75; 95% IC [0.65-0.81]). Diabetes treatment satisfaction was positively correlated with a positive attitude towards CSII therapy (Spearman's rho = 0.31; p < 0.01), less Technology Dependency, higher Ease of Use, and less Impaired Body Image. Furthermore, less Technology Dependency was associated with lower diabetes distress and depressive symptoms. CONCLUSIONS The IT-IPA is a valid and reliable questionnaire evaluating attitudes towards insulin pump therapy. The questionnaire can be used for clinical practice during consultations for shared decision-making to CSII therapy.
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Affiliation(s)
- Rossella Messina
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy.
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy.
| | - Indelicato Liliana
- University of Verona, Verona, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Marica Iommi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Maddalena Trombetta
- University of Verona, Verona, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Timm Roos
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Norbert Hermanns
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Annamaria Di Sipio
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padova, Padua, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo 12, 40126, Bologna, Italy
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
| | - Vincenzo Calvo
- Dipartimento Di Medicina, Azienda Ospedaliera-Università Di Padova, Padua, Italy
- Department of Philosophy, Sociology, Pedagogy, and Applied Psychology, University of Padova, Padua, Italy
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Stanger C, Kowatsch T, Xie H, Nahum-Shani I, Lim-Liberty F, Anderson M, Santhanam P, Kaden S, Rosenberg B. A Digital Health Intervention (SweetGoals) for Young Adults With Type 1 Diabetes: Protocol for a Factorial Randomized Trial. JMIR Res Protoc 2021; 10:e27109. [PMID: 33620330 PMCID: PMC7943343 DOI: 10.2196/27109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. OBJECTIVE In this randomized trial, we will provide a mobile app (SweetGoals) to all participants as a "core" intervention. The app prompts participants to upload data from their diabetes devices weekly to a device-agnostic uploader (Glooko), automatically retrieves uploaded data, assesses daily and weekly self-management goals, and generates feedback messages about goal attainment. Further, the trial will test two unique intervention components: (1) incentives to promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment method and intervention delivery model that transcends the clinic. METHODS A 2x2 factorial randomized trial will be conducted with 300 young adults ages 19-25 with type 1 diabetes and (Hb)A1c ≥ 8.0%. All participants will receive the SweetGoals app that tracks and provides feedback about two adherence targets: (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to the factorial combination of incentives and health coaching. The intervention will last 6 months. The primary outcome will be reduction in A1c. Secondary outcomes include self-regulation mechanisms in longitudinal mediation models and engagement metrics as a predictor of outcomes. Participants will complete 6- and 12-month follow-up assessments. We hypothesize greater sustained A1c improvements in participants who receive coaching and who receive incentives compared to those who do not receive those components. RESULTS Data collection is expected to be complete by February 2025. Analyses of primary and secondary outcomes are expected by December 2025. CONCLUSIONS Successful completion of these aims will support dissemination and effectiveness studies of this intervention that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D. TRIAL REGISTRATION ClinicalTrials.gov NCT04646473; https://clinicaltrials.gov/ct2/show/NCT04646473. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/27109.
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Tobias Kowatsch
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland.,Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Haiyi Xie
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | | | - Molly Anderson
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Prabhakaran Santhanam
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Sarah Kaden
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Briana Rosenberg
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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Wilmot EG, Lumb A, Hammond P, Murphy HR, Scott E, Gibb FW, Platts J, Choudhary P. Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID-19 global pandemic. Diabet Med 2021; 38:e14433. [PMID: 33073388 PMCID: PMC7645943 DOI: 10.1111/dme.14433] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/21/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022]
Abstract
The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID-19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring-generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as for women with type 1 diabetes during pregnancy. The aim of this best practice guide was to clarify the intent and purpose of these international consensus recommendations and to provide practical insights into their implementation in UK diabetes care.
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Affiliation(s)
- E. G. Wilmot
- Diabetes DepartmentRoyal Derby HospitalUniversity Hospitals of Derby and Burton NHS Foundation TrustDerbyUK
- Faculty of Medicine and Health SciencesUniversity of NottinghamNottinghamUK
| | - A. Lumb
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOxfordUK
- NIHR Oxford Biomedical Research CentreOxfordUK
| | - P. Hammond
- Diabetes Resource CentreHarrogate District Hospital, Harrogate and District NHS Foundation TrustHarrogateUK
| | - H. R. Murphy
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Women's Health Academic CentreDivision of Women's and Children's HealthKing's College LondonLondonUK
| | - E. Scott
- Leeds Institute for Cardiovascular and Metabolic MedicineUniversity of LeedsLeedsUK
| | - F. W. Gibb
- Edinburgh Centre for Endocrinology & DiabetesRoyal Infirmary of EdinburghLittle France CrescentEdinburghUK
- Centre for Cardiovascular ScienceUniversity of EdinburghEdinburghUK
| | - J. Platts
- Diabetes CentreUniversity Hospital LlandoughCardiff and Vale University Health BoardPenarthUK
| | - P. Choudhary
- Department of DiabetesSchool of Life Course SciencesKing's College LondonLondonUK
- Leicester Diabetes CentreUniversity of LeicesterLeicesterUK
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Tanenbaum ML, Iturralde E, Hanes SJ, Suttiratana SC, Ambrosino JM, Ly TT, Maahs DM, Naranjo D, Walders-Abramson N, Weinzimer SA, Buckingham BA, Hood KK. Trust in hybrid closed loop among people with diabetes: Perspectives of experienced system users. J Health Psychol 2020; 25:429-438. [PMID: 28810490 PMCID: PMC7162558 DOI: 10.1177/1359105317718615] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.
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Affiliation(s)
| | | | | | | | | | - Trang T Ly
- School of Medicine, Stanford University, USA
- School of Paediatrics and Child Health, The University of Western Australia, Australia
| | - David M Maahs
- School of Medicine, Stanford University, USA
- Barbara Davis Center for Childhood Diabetes, University of Colorado, USA
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Laugesen C, Schmidt S, Tetzschner R, Nørgaard K, Ranjan AG. Glucose Sensor Accuracy After Subcutaneous Glucagon Injections Near to Sensor Site. Diabetes Technol Ther 2020; 22:131-135. [PMID: 31560217 DOI: 10.1089/dia.2019.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Integrated hormone delivery and glucose sensing is warranted, but system performance could be challenged by glucose sensor susceptibility to pharmacological interferences. The aim of this study was to compare sensor accuracy (Medtronic Enlite 2®) after subcutaneous (s.c.) administration of low-dose glucagon near to versus remote from sensor site. Methods: Twelve adults with insulin-pump-treated type 1 diabetes wore two continuous glucose monitors (CGMglucagon and CGMcontrol) placed on each side of the abdomen before, during, and after two overnight 14-h in-clinic visits. During each visit, a s.c. 100 μg glucagon injection was administered 2 cm next to the CGMglucagon followed by another injection of 100 μg glucagon 2 h later at the same site. CGM performance was evaluated using 4-h in-clinic Yellow Spring Instrument (YSI) measurements and 3-day self-monitoring of blood glucose (SMBG) in free-living conditions. Results: Using YSI as comparator, no difference in the median absolute relative difference (MARD) for CGMglucagon (15.7%) and CGMcontrol (13.4%) was found (P = 0.195). Similarly, no difference in MARD was found between CGMglucagon (11.0%) and CGMcontrol (6.2%) using SMBG as comparator (P = 0.148). Values in zone A + B of Clarke error grid analysis did not differ between CGMglucagon and CGMcontrol using YSI (93.9% vs. 91.1%, P = 0.250) and SMBG (97.3% vs. 95.0%, P = 0.375) as reference measurement. The precision absolute relative deviation between sensors was 13.7%. Conclusions: Sensor accuracy was not significantly affected by administration of s.c. glucagon near to sensor site.
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Affiliation(s)
| | - Signe Schmidt
- Steno Diabetes Center Copenhagen, Clinical Research, Gentofte, Denmark
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Danish Diabetes Academy, Odense, Denmark
| | - Rikke Tetzschner
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Kirsten Nørgaard
- Steno Diabetes Center Copenhagen, Clinical Research, Gentofte, Denmark
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ajenthen G Ranjan
- Steno Diabetes Center Copenhagen, Clinical Research, Gentofte, Denmark
- Department of Endocrinology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Danish Diabetes Academy, Odense, Denmark
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8
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Oukes T, Blauw H, van Bon AC, DeVries JH, von Raesfeld AM. Acceptance of the Artificial Pancreas: Comparing the Effect of Technology Readiness, Product Characteristics, and Social Influence Between Invited and Self-Selected Respondents. J Diabetes Sci Technol 2019; 13:899-909. [PMID: 30646756 PMCID: PMC6955445 DOI: 10.1177/1932296818823728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Psychosocial factors that may affect acceptance of artificial pancreas (AP) systems have been investigated in small sample sizes of highly motivated, self-selected persons with type 1 diabetes (T1DM) with a focus on product characteristics. We aimed to develop a valid survey to investigate the association of technology readiness and social influence with AP acceptance in a larger sample, including both self-selected and invited respondents with T1DM. METHODS An online survey was developed based on established questionnaires. Intention to use the AP was chosen as measure of AP acceptance. T1DM patients who signed up themselves for scientific research into AP systems represented the self-selected group, while patients treated at a teaching hospital represented the invited group. Questionnaire values were compared using independent t-tests and regression analyses. RESULTS The developed survey showed reliability and validity. The survey was completed by 425 self-selected and 109 invited persons. Intention to use the AP was high in both groups, but was significantly higher among self-selected respondents. In both groups, intention to use the AP was most strongly related to product compatibility, followed by product complexity, technology readiness, and product usefulness among invited respondents; and followed by product usefulness and technology innovativeness among self-selected respondents. CONCLUSIONS Product characteristics have a stronger relationship with AP acceptance than technology readiness, while social influence does not seem to be associated with AP acceptance. As the (strength of) factors differ between self-selected and invited persons, researchers and product developers should be cautious when relying on self-selected persons with T1DM in the design, development, and testing of AP systems.
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Affiliation(s)
- Tamara Oukes
- Center for Entrepreneurship, Strategy and Innovation Management (ESIM-NIKOS), Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, The Netherlands
- Tamara Oukes, PhD, Center for Entrepreneurship, Strategy and Innovation Management (ESIM-NIKOS), Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, PO Box 217, 7500 AE Enschede; The Netherlands.
| | - Helga Blauw
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Inreda Diabetic BV, Goor, The Netherlands
| | | | - J. Hans DeVries
- Department of Endocrinology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ariane M. von Raesfeld
- Center for Entrepreneurship, Strategy and Innovation Management (ESIM-NIKOS), Faculty of Behavioural, Management and Social Sciences (BMS), University of Twente, Enschede, The Netherlands
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9
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Amiel SA, Choudhary P, Jacob P, Smith EL, De Zoysa N, Gonder-Frederick L, Kendall M, Heller S, Brooks A, Toschi E, Kariyawasam D, Potts L, Healy A, Rogers H, Sevdalis N, Stadler M, Qayyum M, Bakolis I, Goldsmith K. Hypoglycaemia Awareness Restoration Programme for People with Type 1 Diabetes and Problematic Hypoglycaemia Persisting Despite Optimised Self-care (HARPdoc): protocol for a group randomised controlled trial of a novel intervention addressing cognitions. BMJ Open 2019; 9:e030356. [PMID: 31209097 PMCID: PMC6588968 DOI: 10.1136/bmjopen-2019-030356] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Severe hypoglycaemia (SH), when blood glucose falls too low to support brain function, is the most feared acute complication of insulin therapy for type 1 diabetes mellitus (T1DM). 10% of people with T1DM contribute nearly 70% of all episodes, with impaired awareness of hypoglycaemia (IAH) a major risk factor. People with IAH may be refractory to conventional approaches to reduce SH, with evidence for cognitive barriers to hypoglycaemia avoidance. This paper describes the protocol for the Hypoglycaemia Awareness Restoration Programme for People with Type 1 Diabetes and Problematic Hypoglycaemia Persisting Despite Optimised Self-care (HARPdoc) study, a trial to assess the impact on hypoglycaemia experience of a novel intervention that addresses cognitive barriers to hypoglycaemia avoidance, compared with an existing control intervention, recommended by the National Institute of Health and Care Excellence. METHODS AND ANALYSIS A randomised parallel two-arm trial of two group therapies: HARPdoc versus Blood Glucose Awareness Training, among 96 adults with T1DM and problematic hypoglycaemia, despite attendance at education with or without technology use, in four centres providing specialist T1DM services. The primary outcome will be the SH rate at 12 and/or 24 months after randomisation to either course. Secondary outcomes include rates of SH requiring parenteral therapy, involving unconsciousness or needing emergency services; hypoglycaemia awareness status, overall diabetes control and quality of life measures. An implementation study to evaluate how the interventions are delivered and how implementation impacts on clinical effectiveness is planned as a parallel study, with its own protocol. ETHICS AND DISSEMINATION The protocol was approved by the London Dulwich Research Ethics Committee, the Health Research Authority, National Health Service R&D and the Institutional Review Board of the Joslin Diabetes Center in the USA. Study findings will be disseminated to study participants and through peer-reviewed publications and conference presentations, including user groups. TRIAL REGISTRATION NUMBER NCY02940873; Pre-results.
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Affiliation(s)
- Stephanie A Amiel
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Pratik Choudhary
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Peter Jacob
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Emma Lauretta Smith
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Nicole De Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Linda Gonder-Frederick
- Department of Psychiatry and Behavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Mike Kendall
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Simon Heller
- School of Medicine and Biomedical Sciences, University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Augustin Brooks
- Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Bournemouth, UK
| | - Elena Toschi
- Joslin Diabetes Center, Harvard University, Cambridge, Massachusetts, USA
| | - Dulmini Kariyawasam
- Department of Diabetes, Guy's and Saint Thomas' Hospitals NHS Trust, London, UK
| | - Laura Potts
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Andy Healy
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Helen Rogers
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Sciences and Population Research Department, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Marietta Stadler
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Mustabshira Qayyum
- Diabetes Department, Denmark Hill Campus, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Ioannis Bakolis
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Kimberley Goldsmith
- Department of Biostatistics, Department of Health Services and Population Research, Institute of Psychiatry Psychology and Neuroscience, London, UK
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Hermanns N, Ehrmann D, Schipfer M, Kröger J, Haak T, Kulzer B. The impact of a structured education and treatment programme (FLASH) for people with diabetes using a flash sensor-based glucose monitoring system: Results of a randomized controlled trial. Diabetes Res Clin Pract 2019; 150:111-121. [PMID: 30844467 DOI: 10.1016/j.diabres.2019.03.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/31/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
AIMS Flash sensor-based glucose monitoring (FSGM) provides people with diabetes considerably more information on their glycaemic control. We have developed and evaluated a structured education and treatment programme, termed FLASH, to assist FSGM users to understand and use the available glycaemic information for optimization of their diabetes treatment. METHODS We report on a multi-centre, randomized, parallel trial with a six-month follow-up involving 216 eligible participants (16-75 years old) on intensive insulin therapy. The primary outcome was HbA1c change from baseline to six months. Secondary outcomes were measures of glucose control as assessed by FSGM, as well as changes in behavioural and psychosocial measures. RESULTS At six months, the between-group difference in HbA1c reduction was significant, favouring FLASH education compared to the control group receiving no FLASH education (-0.28%, 95% CI -0.16% to -0.40% vs.-0.11%, 95% CI 0.00% to -0.22%; with a between-group difference of -0.17%, 95% CI -0.01% to -0.33%; p = 0.033). Participation in FLASH education also resulted in significant improvements in time spent in the target glucose range, in diabetes-related distress scores and in satisfaction with the glucose monitoring method. FLASH education also resulted in significant improvements in the use of glycaemic information provided by FSGM and in reduced self-monitoring of blood glucose (SMBG) fingerstick testing. CONCLUSION FLASH is an effective programme to improve glycaemic control and lower diabetes-related distress in users of FSGM. The study was registered in ClinicalTrials: NCT03175315.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany; Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany
| | - Melanie Schipfer
- Profusa, Inc., 345 Allerton Ave, South San Francisco, CA 94080, USA
| | - Jens Kröger
- Centre of Diabetology Hamburg Bergedorf, Hamburg, Germany
| | - Thomas Haak
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany; Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany
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11
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Ehrmann D, Kulzer B, Schipfer M, Lippmann-Grob B, Haak T, Hermanns N. Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial. Diabetes Care 2018; 41:2453-2462. [PMID: 30305343 DOI: 10.2337/dc18-0917] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) is the most advanced form of insulin delivery, but it requires structured education to provide users with the necessary knowledge/skills and to support their motivation. Currently, no structured education program designed to provide this training has been evaluated. We developed a CSII-specific, structured education program (Insulin Pump Treatment [INPUT]) and evaluated its impact on glycemic control, behavior, and psychosocial status. RESEARCH DESIGN AND METHODS This was a multicenter, randomized, parallel trial with a 6-month follow-up. Eligible participants (age 16-75 years) currently were treated with insulin pump therapy. Participants were randomly assigned (1:1) to the INPUT program or to usual care using a computer-generated algorithm, with study center as the stratification factor. The primary outcome was HbA1c change from baseline to 6 months. Secondary outcomes were incidence of severe hypoglycemia and changes in behavioral and psychosocial measures. RESULTS Between 1 April 2016 and 26 April 2016, 268 people with diabetes and a mean duration of CSII therapy of 9.5 years were randomly assigned to the INPUT group (n = 135) or control group (n = 133). At 6 months, HbA1c improved in the INPUT group (8.33 ± 0.8 vs. 8.04 ± 0.9; P < 0.0001) but not in the control group (8.33 ± 1.0 vs. 8.27 ± 1.0; P = 0.11). The between-group difference in HbA1c reduction was significant, favoring INPUT (-0.28% vs. -0.06%, Δ -0.22%, 95% CI -0.38 to -0.06; P = 0.0029). The incidence rate ratio of severe hypoglycemia was 3.55 times higher for participants in the control group than for those in the INPUT group (95% CI 1.50-8.43; P = 0.0041). CONCLUSIONS The INPUT education program led to a significant improvement in glycemic control and incidence of severe hypoglycemia in insulin pump users.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Melanie Schipfer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | | | - Thomas Haak
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany .,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
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12
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Waite M, Martin C, Franklin R, Duce D, Harrison R. Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review. JMIR Hum Factors 2018. [PMID: 29535079 PMCID: PMC5871738 DOI: 10.2196/humanfactors.9049] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background People with type 1 diabetes (T1D) undertake self-management to prevent short and long-term complications. Advanced technology potentially supports such activities but requires consideration of psychological and behavioral constructs and usability issues. Economic factors and health care provider capacity influence access and uptake of advanced technology. Previous reviews have focused upon clinical outcomes or were descriptive or have synthesized studies on adults with those on children and young people where human factors are different. Objective This review described and examined the relationship between human factors and adherence with technology for data logging processes in adults with T1D. Methods A systematic literature search was undertaken by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality appraisal was undertaken and data were abstracted and categorized into the themes that underpinned the human factor constructs that were examined. Results A total of 18 studies were included. A total of 6 constructs emerged from the data analysis: the relationship between adherence to data logging and measurable outcomes; satisfaction with the transition to advanced technology for self-management; use of advanced technology and time spent on diabetes-related activities; strategies to mediate the complexities of diabetes and the use of advanced technology; cognition in the wild; and meanings, views, and perspectives from the users of technology. Conclusions Increased treatment satisfaction was found on transition from traditional to advanced technology use—insulin pump and continuous glucose monitoring (CGM); the most significant factor was when blood glucose levels were consistently <7.00 mmol/L (P ≤.01). Participants spent considerable time on their diabetes self-care. Logging of data was positively correlated with increasing age when using an app that provided meaningful feedback (regression coefficient=55.8 recordings/year; P ≤.01). There were benefits of CGM for older people in mediating complexities and fears of hypoglycemia with significant differences in well-being (P ≤.001). Qualitative studies explored the contextual use and uptake of technology. The results suggested frustrations with CGM, continuous subcutaneous insulin infusion, calibration of devices, and alarms. Furthermore implications for “body image” and the way in which “significant others” impacted on the behavior and attitude of the individual toward technology use. There were wide variations in the normal use of and interaction with technology across a continuum of sociocultural contexts, which has implications for the way in which future technologies should be designed. Quantitative studies were limited by small sample sizes, making it difficult to generalize findings to other contexts. This was further limited by a sample that was predominantly white, well-controlled, and engaged with self-care. The use of critical appraisal frameworks demonstrated where research into human factors and data logging processes of individuals could be improved. This included engaging people in the design of the technology, especially hard-to-reach or marginalized groups.
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Affiliation(s)
- Marion Waite
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Clare Martin
- Faculty of Technology, Design & Engineering, Oxford Brookes University, Oxford, United Kingdom
| | - Rachel Franklin
- Oxford Centre for Diabetes, Endocrinology & Metabolism, University of Oxford, Oxford, United Kingdom
| | - David Duce
- Faculty of Technology, Design & Engineering, Oxford Brookes University, Oxford, United Kingdom
| | - Rachel Harrison
- Faculty of Technology, Design & Engineering, Oxford Brookes University, Oxford, United Kingdom
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13
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Lea Sara Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes , Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Katharine Barnard
- 2 Faculty of Health and Social Sciences, Bournemouth University , Bournemouth, United Kingdom
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14
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Iturralde E, Tanenbaum ML, Hanes SJ, Suttiratana SC, Ambrosino JM, Ly TT, Maahs DM, Naranjo D, Walders-Abramson N, Weinzimer SA, Buckingham BA, Hood KK. Expectations and Attitudes of Individuals With Type 1 Diabetes After Using a Hybrid Closed Loop System. Diabetes Educ 2017; 43:223-232. [PMID: 28340542 DOI: 10.1177/0145721717697244] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study was to explore the benefits, expectations, and attitudes of individuals with T1D following a clinical trial of an HCL system. Methods Thirty-two individuals with T1D (17 adults, 15 adolescents) participated in focus groups after 4 to 5 days of system use. Content analysis generated themes regarding perceived benefits, hassles, and limitations. Results Some participants felt misled by terms such as "closed loop" and "artificial pancreas," which seemed to imply a more "hands-off" experience. Perceived benefits were improved glycemic control, anticipated reduction of long-term complications, better quality of life, and reduced mental burden of diabetes. Hassles and limitations included unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and being reminded of diabetes. Conclusion Users are willing to accept some hassles and limitations if they also perceive health and quality-of-life benefits beyond current self-management. It is important for clinicians to provide a balanced view of positives and negatives to help manage expectations.
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Affiliation(s)
- Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood)
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood)
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood)
| | - Sakinah C Suttiratana
- Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California (Ms Suttiratana)
| | - Jodie M Ambrosino
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut (Dr Ambrosino, Dr Weinzimer)
| | - Trang T Ly
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood).,Insulet Corporation, Billerica, Massachusetts (Dr Ly)
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood).,Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado (Dr Maahs, Dr Walders-Abramson)
| | - Diana Naranjo
- Department of Psychiatry, Stanford University School of Medicine, Stanford, California (Dr Naranjo, Dr Hood)
| | - Natalie Walders-Abramson
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado (Dr Maahs, Dr Walders-Abramson)
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut (Dr Ambrosino, Dr Weinzimer)
| | - Bruce A Buckingham
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood)
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California (Dr Iturralde, Dr Tanenbaum, Ms Hanes, Dr Ly, Dr Maahs, Dr Buckingham, Dr Hood).,Department of Psychiatry, Stanford University School of Medicine, Stanford, California (Dr Naranjo, Dr Hood)
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15
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Gildersleeve R, Riggs SL, Cherñavvsky DR, Breton MD, DeBoer MD. Improving the Safety and Functionality of an Artificial Pancreas System for Use in Younger Children: Input from Parents and Physicians. Diabetes Technol Ther 2017; 19:660-674. [PMID: 28854339 DOI: 10.1089/dia.2017.0150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Artificial pancreas (AP) systems have initially been designed for and tested in teens and adults, but there is evidence that an AP system with additional support and safety systems could greatly benefit younger children with type 1 diabetes (T1D). SUBJECTS AND METHODS Five pediatric endocrinologists and 15 parents of children aged 5-8 years with T1D participated in a total of four focus groups. Focus groups investigated current diabetes technology use and acceptance, as well as possible modifications to the current adult AP system, which would allow for safe and successful use in younger children. Modifications discussed include child-specific functionality for input tasks, safety features, and monitoring capabilities. RESULTS Participant suggestions included the following: passcodes for differential access to AP features by parents, ancillary caregivers, and the child; preset early, intermediate, and advanced child access categories; maximal customization for general and alarm settings; simplified meal screens utilizing the AP' corrective blood glucose (BG) ability; automated exercise mode; spoken and dictated messaging capabilities; emergency contacts; treatment instructions for the child and caregiver; remote monitoring website and application; animated continuous glucose monitor BG trace; gamification, such as rewarding diabetes-friendly behaviors; and comprehensive training of all individuals involved in the child's diabetes care. CONCLUSION Parents and physicians were eager for AP applications to be available for younger children, but stressed that a modified system could better serve this group's needs for safety and improved diabetes-related communication. The diverse and emerging needs of 5-8-year olds require flexible and customizable systems for T1D management.
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Affiliation(s)
- Rachel Gildersleeve
- 1 Center for Diabetes Technology, University of Virginia , Charlottesville, Virginia
| | - Sara L Riggs
- 2 Department of Industrial Engineering, Clemson University , Clemson, South Carolina
| | - Daniel R Cherñavvsky
- 1 Center for Diabetes Technology, University of Virginia , Charlottesville, Virginia
- 3 TypeZero Technologies, Inc. , Charlottesville, Virginia
| | - Marc D Breton
- 1 Center for Diabetes Technology, University of Virginia , Charlottesville, Virginia
- 3 TypeZero Technologies, Inc. , Charlottesville, Virginia
| | - Mark D DeBoer
- 1 Center for Diabetes Technology, University of Virginia , Charlottesville, Virginia
- 4 Department of Pediatrics, Division of Pediatric Endocrinology, University of Virginia , Charlottesville, Virginia
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16
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Affiliation(s)
- Eric Racine
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal.,Department of Experimental Medicine, McGill University.,Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal.,Department of Neurology and Neurosurgery, McGill University
| | - Ariane Quintal
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal.,Department of Medicine and Department of Social and Preventive Medicine, Université de Montréal
| | - Matthew Sample
- Neuroethics Research Unit, Institut de recherches cliniques de Montréal.,Department of Neurology and Neurosurgery, McGill University
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17
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Troncone A, Bonfanti R, Iafusco D, Rabbone I, Sabbion A, Schiaffini R, Galderisi A, Marigliano M, Rapini N, Rigamonti A, Tinti D, Vallone V, Zanfardino A, Boscari F, Del Favero S, Galasso S, Lanzola G, Messori M, Di Palma F, Visentin R, Calore R, Leal Y, Magni L, Losiouk E, Chernavvsky D, Quaglini S, Cobelli C, Bruttomesso D. Evaluating the Experience of Children With Type 1 Diabetes and Their Parents Taking Part in an Artificial Pancreas Clinical Trial Over Multiple Days in a Diabetes Camp Setting. Diabetes Care 2016; 39:2158-2164. [PMID: 27852685 DOI: 10.2337/dc16-1073] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/08/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore the experiences of children with type 1 diabetes and their parents taking part in an artificial pancreas (AP) clinical trial during a 7-day summer camp. RESEARCH DESIGN AND METHODS A semistructured interview, composed of 14 questions based on the Technology Acceptance Model, was conducted at the end of the clinical trial. Participants also completed the Diabetes Treatment Satisfaction Questionnaire (DTSQ, parent version) and the AP Acceptance Questionnaire. RESULTS Thirty children, aged 5-9 years, and their parents completed the study. A content analysis of the interviews showed that parents were focused on understanding the mechanisms, risks, and benefits of the new device, whereas the children were focused on the novelty of the new system. The parents' main concerns about adopting the new system seemed related to the quality of glucose control. The mean scores of DTSQ subscales indicated general parents' satisfaction (44.24 ± 5.99, range 32-53) and trustful views of diabetes control provided by the new system (7.8 ± 2.2, range 3-12). The AP Acceptance Questionnaire revealed that most parents considered the AP easy to use (70.5%), intended to use it long term (94.0%), and felt that it was apt to improve glucose control (67.0%). CONCLUSIONS Participants manifested a positive attitude toward the AP. Further studies are required to explore participants' perceptions early in the AP development to individualize the new treatment as much as possible, and to tailor it to respond to their needs and values.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Riccardo Bonfanti
- Pediatric Department and Diabetes Research Institute, Scientific Institute, Hospital San Raffaele, Milan, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Alberto Sabbion
- Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders Unit, Azienda Ospedialiera Universitaria Integrata of Verona, Verona, Italy
| | - Riccardo Schiaffini
- Unit of Endocrinology and Diabetes, Bambino Gesù, Children's Hospital, Rome, Italy
| | - Alfonso Galderisi
- Department of Woman's and Child's Health, University of Padua, Padua, Italy
| | - Marco Marigliano
- Regional Center for Pediatric Diabetes, Pediatric Diabetes and Metabolic Disorders Unit, Azienda Ospedialiera Universitaria Integrata of Verona, Verona, Italy
| | - Novella Rapini
- Pediatric Diabetology Unit, Policlinico di Tor Vergata, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Rigamonti
- Pediatric Department and Diabetes Research Institute, Scientific Institute, Hospital San Raffaele, Milan, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Valeria Vallone
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padova, Padova, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Federico Boscari
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padova, Padova, Italy
| | - Simone Del Favero
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Silvia Galasso
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padova, Padova, Italy
| | - Giordano Lanzola
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Mirko Messori
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Federico Di Palma
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Roberto Visentin
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Roberta Calore
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Yenny Leal
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Lalo Magni
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Eleonora Losiouk
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Daniel Chernavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Daniela Bruttomesso
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padova, Padova, Italy
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Barnard KD, Hood KK, Weissberg-Benchell J, Aldred C, Oliver N, Laffel L. Psychosocial assessment of artificial pancreas (AP): commentary and review of existing measures and their applicability in AP research. Diabetes Technol Ther 2015; 17:295-300. [PMID: 25549042 PMCID: PMC4365433 DOI: 10.1089/dia.2014.0305] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM This study aimed to systematically review the evidence base for the use of existing psychological and psychosocial measures suitable for use in artificial pancreas (AP) research. MATERIALS AND METHODS This systematic review of published literature, gray literature, previous systematic reviews, and qualitative and economic studies was conducted using terms and abbreviations synonymous with diabetes, AP, and quality of life (QoL). RESULTS Two hundred ninety-two abstracts were identified that reported psychosocial assessment of diabetes-related technologies. Of these, nine met the inclusion criteria and were included. Only four of 103 ongoing trials evaluated psychosocial aspects as an outcome in the trial. Of these, treatment satisfaction, acceptance and use intention of AP, fear of hypoglycemia episodes, satisfaction with AP, and an unspecified QoL measure were used. CONCLUSIONS A better understanding of the psychosocial side of AP systems and the extent to which human factors play a role in the uptake and efficient use of these systems will ultimately lead to the most benefit for people with diabetes.
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Affiliation(s)
- Katharine D. Barnard
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Korey K. Hood
- Pediatrics, Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Chris Aldred
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Nick Oliver
- Imperial College London, London, United Kingdom
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
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19
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Powell PW, Corathers SD, Raymond J, Streisand R. New approaches to providing individualized diabetes care in the 21st century. Curr Diabetes Rev 2015; 11:222-30. [PMID: 25901504 PMCID: PMC4864491 DOI: 10.2174/1573399811666150421110316] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/22/2015] [Accepted: 03/23/2015] [Indexed: 01/06/2023]
Abstract
Building from a foundation of rapid innovation, the 21(st) century is poised to offer considerable new approaches to providing modern diabetes care. The focus of this paper is the evolving role of diabetes care providers collaboratively working with patients and families toward the goals of achieving optimal clinical and psychosocial outcomes for individuals living with diabetes. Advances in monitoring, treatment and technology have been complemented by trends toward patient-centered care with expertise from multiple health care disciplines. The evolving clinical care delivery system extends far beyond adjustment of insulin regimens. Effective integration of patient-centered strategies, such as shared-decision making, motivational interviewing techniques, shared medical appointments, and multidisciplinary team collaboration, into a dynamic model of diabetes care delivery holds promise in reaching glycemic targets and improving patients' quality of life.
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Affiliation(s)
- Priscilla W Powell
- Children`s Hospital of Richmond at VCU, Brook Road Campus, 2924 Brook Road, Richmond, VA 23220-1298, USA.
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20
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Ziegler C, Liberman A, Nimri R, Muller I, Klemenčič S, Bratina N, Bläsig S, Remus K, Phillip M, Battelino T, Kordonouri O, Danne T, Lange K. Reduced Worries of Hypoglycaemia, High Satisfaction, and Increased Perceived Ease of Use after Experiencing Four Nights of MD-Logic Artificial Pancreas at Home (DREAM4). J Diabetes Res 2015; 2015:590308. [PMID: 26581230 PMCID: PMC4637058 DOI: 10.1155/2015/590308] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/05/2015] [Indexed: 01/08/2023] Open
Abstract
AIMS This study assesses the impact of using an AP-system at home on fear of hypoglycaemia. In addition, satisfaction and acceptance of the new technology are evaluated. METHODS In a multicentre, multinational study of 75 patients using the MD-Logic AP during four consecutive nights in home setting 59 of them (aged 10-54 years, 54% male, HbA1c 7.89 ± 0.69% [62.72 ± 7.51 mmol/mol], diabetes duration 11.6 ± 8.4 yrs) answered standardized questionnaires (HFS, adapted TAM, and AP satisfaction) before and after using the AP. RESULTS After experiencing the AP in home setting worries of hypoglycaemia were significantly reduced (before 1.04 ± 0.53 versus after 0.90 ± 0.63; P = 0.017). Perceived ease of use as a measure of acceptance with the AP significantly increased after personal experience (before 4.64 ± 0.94 versus after 5.06 ± 1.09; P = 0.002). The overall satisfaction mean score after using the AP was 3.02 ± 0.54 (range 0-4), demonstrating a high level of satisfaction with this technology. CONCLUSIONS The four-night home-based experience of using MD Logic AP was associated with reduced worries of hypoglycaemia, high level of satisfaction, and increased perceived ease of use of the new technology in children, adolescents, and adults.
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Affiliation(s)
- Claudia Ziegler
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
- *Claudia Ziegler:
| | - Alon Liberman
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Ido Muller
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Simona Klemenčič
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Sarah Bläsig
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Kerstin Remus
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, 49202 Petah Tikva, Israel
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus AUF DER BULT, 30173 Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, 30625 Hannover, Germany
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Bevier WC, Fuller SM, Fuller RP, Rubin RR, Dassau E, Doyle FJ, Jovanovič L, Zisser HC. Artificial pancreas (AP) clinical trial participants' acceptance of future AP technology. Diabetes Technol Ther 2014; 16:590-5. [PMID: 24811147 PMCID: PMC4135316 DOI: 10.1089/dia.2013.0365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Artificial pancreas (AP) systems are currently an active field of diabetes research. This pilot study examined the attitudes of AP clinical trial participants toward future acceptance of the technology, having gained firsthand experience. SUBJECTS AND METHODS After possible influencers of AP technology adoption were considered, a 34-question questionnaire was developed. The survey assessed current treatment satisfaction, dimensions of clinical trial participant motivation, and variables of the technology acceptance model (TAM). Forty-seven subjects were contacted to complete the survey. The reliability of the survey scales was tested using Cronbach's α. The relationship of the factors to the likelihood of AP technology adoption was explored using regression analysis. RESULTS Thirty-six subjects (76.6%) completed the survey. Of the respondents, 86.1% were either highly likely or likely to adopt the technology once available. Reliability analysis of the survey dimensions revealed good internal consistency, with scores of >0.7 for current treatment satisfaction, convenience (motivation), personal health benefit (motivation), perceived ease of use (TAM), and perceived usefulness (TAM). Linear modeling showed that future acceptance of the AP was significantly associated with TAM and the motivation variables of convenience plus the individual item benefit to others (R(2)=0.26, P=0.05). When insulin pump and continuous glucose monitor use were added, the model significance improved (R(2)=0.37, P=0.02). CONCLUSIONS This pilot study demonstrated that individuals with direct AP technology experience expressed high likelihood of future acceptance. Results support the factors of personal benefit, convenience, perceived usefulness, and perceived ease of use as reliable scales that suggest system adoption in this highly motivated patient population.
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Affiliation(s)
- Wendy C. Bevier
- Sansum Diabetes Research Institute, Santa Barbara, California
| | - Serena M. Fuller
- Department of Family and Consumer Sciences, University of Arkansas Division of Agriculture Research and Extension, Little Rock, Arkansas
| | - Ryan P. Fuller
- Department of Speech Communication, University of Arkansas at Little Rock, Little Rock, Arkansas
| | - Richard R. Rubin
- Departments of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eyal Dassau
- Sansum Diabetes Research Institute, Santa Barbara, California
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California
| | - Francis J. Doyle
- Sansum Diabetes Research Institute, Santa Barbara, California
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- Institute for Collaborative Biotechnologies, University of California Santa Barbara, Santa Barbara, California
| | - Lois Jovanovič
- Sansum Diabetes Research Institute, Santa Barbara, California
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
- Biomolecular Science & Engineering Program, University of California Santa Barbara, Santa Barbara, California
| | - Howard C. Zisser
- Sansum Diabetes Research Institute, Santa Barbara, California
- Department of Chemical Engineering, University of California Santa Barbara, Santa Barbara, California
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