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Psychosocial aspects of closed‐ and open‐loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting

Psychosocial aspects of closed‐ and open‐loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting
Psychosocial aspects of closed‐ and open‐loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting
Aims: To explore the psychosocial experiences of closed‐loop technology and to compare ratings of closed‐ and open‐loop technology for adults with Type 1 diabetes taking part in a randomized crossover study.Methods: Adults (aged > 18 years) on insulin pump therapy were recruited to receive a first phase of either real‐time continuous glucose monitoring with overnight closed‐loop or real‐time continuous glucose monitoring alone (open‐loop) followed by a second phase of the alternative treatment in random order, at home for 4 weeks, unsupervised. Participants were invited to share their views in semi‐structured interviews. The impact of the closed‐loop technology, positive and negative aspects of living with the device overnight, along with the hopes and anxieties of the participants, were explored.Results: The participants in the trial were 24 adults with a mean (sd) age of 43 (12) years, of whom 54% were men. The mean (range) interview duration was 26 (12–46) min. Content and thematic analysis showed the following key positive themes: improved blood glucose control (n = 16); reassurance/reduced worry (n = 16); improved overnight control leading to improved daily functioning and diabetes control (n = 16); and improved sleep (n = 8). The key negative themes were: technical difficulties (n = 24); intrusiveness of alarms (n = 13); and size of equipment (n = 7). Of the 24 participant, 20 would recommend the closed‐loop technology.Conclusions: Closed‐loop therapy has positive effects when it works in freeing participants from the demands of self‐management. The downside was technical difficulties, particularly concerning the pump and ‘connectivity’, which it is hoped will improve. Future research should continue to explore the acceptability of the closed‐loop system as a realistic therapy option, taking account of user concerns as new systems are designed. Failure to do this may reduce the eventual utility of new systems.
0742-3071
601-608
Barnard, K.D.
1ade2840-48a4-4bb3-b564-0a058df8297f
Wysocki, T.
88de2d79-94f0-4fea-b9a5-ed714c039a68
Thabit, H.
e318c67d-9240-413b-985b-471e02fc8b32
Evans, M.L.
a0936056-1650-44f6-8da7-fa5f5e0abda1
Amiel, S.
1fd69f03-c060-42b8-9241-79b3d8520b38
Heller, S.
79654ac6-499e-40f6-90cd-253b103efe11
Young, A.
6bb7aa9c-776b-4bdd-be4e-cf67abd05652
Hovorka, R.
052792f8-f03a-4571-ab55-001209395a82
Barnard, K.D.
1ade2840-48a4-4bb3-b564-0a058df8297f
Wysocki, T.
88de2d79-94f0-4fea-b9a5-ed714c039a68
Thabit, H.
e318c67d-9240-413b-985b-471e02fc8b32
Evans, M.L.
a0936056-1650-44f6-8da7-fa5f5e0abda1
Amiel, S.
1fd69f03-c060-42b8-9241-79b3d8520b38
Heller, S.
79654ac6-499e-40f6-90cd-253b103efe11
Young, A.
6bb7aa9c-776b-4bdd-be4e-cf67abd05652
Hovorka, R.
052792f8-f03a-4571-ab55-001209395a82

Barnard, K.D., Wysocki, T., Thabit, H., Evans, M.L., Amiel, S., Heller, S., Young, A. and Hovorka, R. (2015) Psychosocial aspects of closed‐ and open‐loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting. Diabetic Medicine, 32 (5), 601-608. (doi:10.1111/dme.12706).

Record type: Article

Abstract

Aims: To explore the psychosocial experiences of closed‐loop technology and to compare ratings of closed‐ and open‐loop technology for adults with Type 1 diabetes taking part in a randomized crossover study.Methods: Adults (aged > 18 years) on insulin pump therapy were recruited to receive a first phase of either real‐time continuous glucose monitoring with overnight closed‐loop or real‐time continuous glucose monitoring alone (open‐loop) followed by a second phase of the alternative treatment in random order, at home for 4 weeks, unsupervised. Participants were invited to share their views in semi‐structured interviews. The impact of the closed‐loop technology, positive and negative aspects of living with the device overnight, along with the hopes and anxieties of the participants, were explored.Results: The participants in the trial were 24 adults with a mean (sd) age of 43 (12) years, of whom 54% were men. The mean (range) interview duration was 26 (12–46) min. Content and thematic analysis showed the following key positive themes: improved blood glucose control (n = 16); reassurance/reduced worry (n = 16); improved overnight control leading to improved daily functioning and diabetes control (n = 16); and improved sleep (n = 8). The key negative themes were: technical difficulties (n = 24); intrusiveness of alarms (n = 13); and size of equipment (n = 7). Of the 24 participant, 20 would recommend the closed‐loop technology.Conclusions: Closed‐loop therapy has positive effects when it works in freeing participants from the demands of self‐management. The downside was technical difficulties, particularly concerning the pump and ‘connectivity’, which it is hoped will improve. Future research should continue to explore the acceptability of the closed‐loop system as a realistic therapy option, taking account of user concerns as new systems are designed. Failure to do this may reduce the eventual utility of new systems.

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More information

Accepted/In Press date: 19 January 2015
e-pub ahead of print date: 23 January 2015
Published date: May 2015

Identifiers

Local EPrints ID: 424156
URI: https://eprints.soton.ac.uk/id/eprint/424156
ISSN: 0742-3071
PURE UUID: 7f75d276-53ab-497c-aef3-1d3279509c5e
ORCID for A. Young: ORCID iD orcid.org/0000-0002-1486-5561

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Date deposited: 05 Oct 2018 11:31
Last modified: 20 Jul 2019 01:01

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Contributors

Author: K.D. Barnard
Author: T. Wysocki
Author: H. Thabit
Author: M.L. Evans
Author: S. Amiel
Author: S. Heller
Author: A. Young ORCID iD
Author: R. Hovorka

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