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

• DOI: 10.1111/dme.12706
• Publication Date: 2015-01-23T13:21:45Z
• Authors: K. D. Barnard; T. Wysocki; H. Thabit; M. L. Evans; S. Amiel; S. Heller; A. Young; R. Hovorka
• Keywords: Adult; Blood Glucose; Male; 610; Anxiety; 03 medical and health sciences; Insulin Infusion Systems; 0302 clinical medicine; Surveys and Questionnaires; Interview, Psychological; Ambulatory Care; Humans; Hypoglycemic Agents; Insulin; Psychology; Cross-Over Studies; Blood Glucose/metabolism; Incidence; Insulin Infusion Systems/classification; 600; Diabetes Mellitus, Type 1/blood; Middle Aged; Hypoglycemic Agents/administration & dosage; 16. Peace & justice; 3. Good health; Self Care; Diabetes Mellitus, Type 1; Treatment Outcome; Patient Satisfaction; Female; Insulin/administration & dosage; Anxiety/epidemiology

AbstractAimsTo 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.MethodsAdults (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.ResultsThe 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.ConclusionsClosed‐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.