File(s) under permanent embargo

"It is definitely a game changer": a qualitative study of experiences with in-home overnight closed-loop technology among adults with Type 1 diabetes

journal contribution
posted on 01.07.2017, 00:00 authored by Christel HendrieckxChristel Hendrieckx, Lucinda Poole, A Sharifi, D Jayawardene, M M Loh, J C Horsburgh, L A Bach, P G Colman, K Kumareswaran, A J Jenkins, R J MacIsaac, G M Ward, B Grosman, A Roy, D N O'Neal, Jane SpeightJane Speight
BACKGROUND: This qualitative study explored trial participants' experiences of four nights of in-home closed loop.
METHODS: Sixteen adults with type 1 diabetes, who completed a randomized crossover trial, were interviewed after four consecutive nights of closed-loop. Interviews were audio recorded, transcribed, and analyzed with a coding framework developed to identify the main themes.
RESULTS: Participants had a mean age of 42 ± 10 years, nine were women; mean diabetes duration was 27 ± 7 years, and all were using insulin pumps. Overall, first impressions were positive. Participants found closed-loop easy to use and understand. Most experienced more stable overnight glucose levels, although for some these were similar to usual care or higher than they expected. Compared with their usual treatment, they noticed the proactive nature of the closed-loop, being able to predict trends and deliver micro amounts of insulin. Most reported technical glitches or inconveniences during one or more nights, such as transmission problems, problematic connectivity between devices, ongoing alarms despite addressing low glucose levels, and sensor inaccuracy. Remote monitoring by the trial team and their own hypoglycemic awareness contributed to feelings of trust and safety. Although rare, safety concerns were raised, related to feeling unsure whether the system would respond in time to falling glucose levels. CONCLUSIONS: This study provides relevant insights for implementation of closed-loop in the real world. For people with diabetes who are less familiar with technology, remote monitoring for the first few days may provide reassurance, strengthen their trust/skills, and make closed-loop an acceptable option for more people with type 1 diabetes.

History

Journal

Diabetes Technology & Therapeutics

Volume

19

Issue

7

Pagination

410 - 416

Publisher

Mary Ann Liebert Publishers

Location

New Rochelle, N.Y.

ISSN

1520-9156

eISSN

1557-8593

Language

eng

Publication classification

C Journal article; C1 Refereed article in a scholarly journal

Copyright notice

2017, Mary Ann Liebert Publishers