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

Abstract

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.

What Training, Support, and Resourcing Do Health Professionals Need to Support People Using a Closed-Loop System? A Qualitative Interview Study with Health Professionals Involved in the Closed Loop from Onset in Type 1 Diabetes (CLOuD) Trial

“…This prompted concerns about having fewer opportunities to reinforce critical diabetes management skills, such as how to independently adjust basal rates and mealtime ratios in the event of device failure. Resonating with others' observations, interviewees also described how some people had held unrealistic expectations about the system's capabilities 9,12 and could feel overly anxious due to the greater availability of real-time blood glucose data. 23 To address these concerns, we recommend the development of a structured, stepwise education package.…”

“…Our epistemological position was informed by the literature on the evaluation of complex health interventions 16 as well as earlier work, which has highlighted how unexpected issues, benefits, and challenges may arise from introducing and using new diabetes technologies. 12,13…”

“…To date, most studies have focused on the experiences of people with type 1 diabetes and/or their family members when using closed-loop systems. [3][4][5][6][7][8][9][10][11][12][13] Health professionals' perspectives have only received limited attention, including their views about the training, support, and resourcing needed to support individuals using the technology in routine clinical care. This is an important omission, given the evidence that a key mediating factor in people's access to and experience of using diabetes technologies is professionals being appropriately trained and supported.…”

The DIY artificial pancreas system: an ethical dilemma for doctors

“…They consist of an insulin pump that can alter the amount of insulin delivered from moment to moment in response to the interstitial glucose measured by a continuous glucose monitor. In combination, these systems deliver optimal glucose control, reduce hypoglycaemia and improve quality of life [3]; however, they are not readily available in routine clinical practice. Closed-loop systems have been used in research settings for over a decade, with many studies reporting their use, but commercially available systems are not yet widely available [4][5][6].…”

A qualitative study exploring the expectations of people living with type 1 diabetes regarding prospective use of a hybrid closed‐loop system

“…In accordance with patient-centred care, uptake of hybrid closed-loop systems will jointly depend on clinical effectiveness and considerations of patient preferences [6,7]. To this end, several qualitative studies report on appreciation of experimental hybrid closed-loop systems for adults with type 1 diabetes [8][9][10][11][12][13][14][15][16]. Users were generally satisfied with these systems.…”