Improving the Safety and Functionality of an Artificial Pancreas System for Use in Younger Children: Input from Parents and Physicians

Gildersleeve, Rachel; Riggs, Sara L.; Cherñavvsky, Daniel R.; Breton, Marc D.; DeBoer, Mark D.

doi:10.1089/dia.2017.0150

Cited by 10 publications

(30 citation statements)

References 34 publications

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“…This stresses the importance of studying product characteristics in AP system acceptance research identified in previous literature. 6,10,13,15,16,18,19 Moreover, it contributes to this literature by providing insight into two additional factors: technology readiness and social influence.…”

Section: Discussionmentioning

confidence: 97%

“…[10][11][12] Previous research into psychosocial factors has given relevant insights into the overall likelihood of AP systems' future acceptance. 10,[13][14][15][16][17] In addition, it has identified two potential determinants of AP acceptance: product characteristics (ie, ease of use and usefulness) 6,10,13,15,16,18,19 and treatment satisfaction. 10,13 Bevier et al 10 have statistically examined the relationship between AP system acceptance and its determinants.…”

mentioning

confidence: 99%

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Acceptance of the Artificial Pancreas: Comparing the Effect of Technology Readiness, Product Characteristics, and Social Influence Between Invited and Self-Selected Respondents

Oukes

Blauw

Bon

et al. 2019

J Diabetes Sci Technol

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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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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

Acceptance of the Artificial Pancreas: Comparing the Effect of Technology Readiness, Product Characteristics, and Social Influence Between Invited and Self-Selected Respondents

Oukes

Blauw

Bon

et al. 2019

J Diabetes Sci Technol

View full text Add to dashboard Cite

show abstract

“…Families have grown accustomed to remote monitoring of CGM data; many will seek closed-loop insulin delivery systems that afford this option (32). Parents of infants and toddlers value insulin pump systems that have incorporated remote bolusing features, and similar functions should be incorporated in HCL systems.…”

Section: New Features To Promote Hcl Use In Pediatricsmentioning

confidence: 99%

“…Parents of infants and toddlers value insulin pump systems that have incorporated remote bolusing features, and similar functions should be incorporated in HCL systems. While limited access to various system features may be desired for youngsters, as children mature and display greater understanding of their own condition, the use of passcodes or variable access categories may allow the system to "grow" with them (32). Other focus groups have expressed the desire for these devices to be more discreet (33).…”

Section: New Features To Promote Hcl Use In Pediatricsmentioning

confidence: 99%

Closing the Loop on Managing Youth With Type 1 Diabetes: Children Are Not Just Small Adults

Sherr

2018

Diabetes Care

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As hybrid closed-loop (HCL) insulin delivery systems permeate clinical practice, it is critical to ensure all with diabetes are afforded the opportunity to benefit from this technology. Indeed, due to the suboptimal control achieved by the vast majority of youth with type 1 diabetes (T1D), pediatric patients are positioned to see the greatest benefit from automated insulin delivery systems. To ensure these systems are well poised to deliver the promise of more targeted control, it is essential to understand the unique characteristics and factors of childhood. Herein, the developmental and physiological needs ofyouth with T1Dare reviewed and consideration is given to how HCL could address these issues. Studies of HCL technologies in youth are briefly reviewed. As future-generation closed-loop systems are being devised, features that could make this technology more attractive to youth and to their families are discussed. Integration of HCL has the potential to minimize the burden of this chronic medical condition while improving glycemic control and ultimately allowing our pediatric patients to fulfill the primary goal of childhood, to be a kid."Children are not small adults" is a phrase that every pediatric practitioner becomes well aware of during training. Indeed, the developmental changes that are the hallmark of this stage of life will never be recapitulated. In growing children with type 1 diabetes (T1D), the burden of having to constantly adjust insulin needs is a neverending challenge, especially when growth and development accelerate during puberty. It is not surprising that the summit of suboptimal control of T1D is observed in adolescence (1). Pivotal trials of new drugs and technologies for diabetes are typically carried out first in adults, not only to avoid unnecessary exposure of children to unexpected adverse effects of new therapies but also because near-optimal control of T1D is much more common in adults than in children and adolescents. Thus, it is of utmost importance to consider factors that require special attention during childhood.In our youngest patients, the inability to communicate needs may lead caregivers to adopt a strategy of constant vigilance (2). Despite such vigilance, it was reported that 90% of hypoglycemic events detected by blinded continuous glucose monitoring (CGM) in infants and toddlers occurred without concomitant symptoms of hypoglycemia detected by their caregivers (3). Due to unpredictable changes in appetite and food intake, many families of young children administer meal boluses after instead of before eating, even at the expense of greater postprandial hyperglycemia and the suboptimal glycemic control that this approach is associated with (4). Nighttime is often the worst time for parents of young children with diabetes due to fears about hypoglycemia, which leads to disturbed sleep patterns secondary to the need to monitor overnight blood glucose levels two or more times per night (5,6).School-aged children are in the care of numerous adults throughout the day: p...

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“…To improve usability and acceptability, studies have elicited a user perspective. [1][2][3] Many have consulted individuals who have no direct experience of using the technology 1,[3][4][5][6] and have found that, as well as having high expectations, people question whether they will be able to trust the system. [3][4][5] This has prompted concerns that people's attitudes and expectations may present barriers to using the technology.…”

Section: Introductionmentioning

confidence: 99%

Participants' Experiences of, and Views About, Daytime Use of a Day-and-Night Hybrid Closed-Loop System in Real Life Settings: Longitudinal Qualitative Study

Lawton

Blackburn

Rankin

et al. 2019

Diabetes Technology & Therapeutics

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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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Improving the Safety and Functionality of an Artificial Pancreas System for Use in Younger Children: Input from Parents and Physicians

Cited by 10 publications

References 34 publications

Acceptance of the Artificial Pancreas: Comparing the Effect of Technology Readiness, Product Characteristics, and Social Influence Between Invited and Self-Selected Respondents

Acceptance of the Artificial Pancreas: Comparing the Effect of Technology Readiness, Product Characteristics, and Social Influence Between Invited and Self-Selected Respondents

Closing the Loop on Managing Youth With Type 1 Diabetes: Children Are Not Just Small Adults

Participants' Experiences of, and Views About, Daytime Use of a Day-and-Night Hybrid Closed-Loop System in Real Life Settings: Longitudinal Qualitative Study

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