Psychological outcomes of evening and night closed‐loop insulin delivery under free living conditions in people with Type 1 diabetes: a 2‐month randomized crossover trial

Abstract

AimTo assess the impact on fear of hypoglycaemia and treatment satisfaction with an artificial pancreas system used for 2 consecutive months, as well as participant acceptance of the artificial pancreas system.MethodsIn a randomized crossover trial patient‐related outcomes associated with an evening‐and‐night artificial pancreas and sensor‐augmented pump therapy were compared. Both intervention periods lasted 8 weeks. The artificial pancreas acceptance questionnaire (range 0–90, higher scores better), Hypoglycaemia Fear Survey II (range 0–72, higher scores worse) and Diabetes Treatment Satisfaction Questionnaire (range 0–36, higher scores better) were completed by 32 participants. Semi‐structured interviews were conducted after study completion in a subset of six participants. Outcomes were compared using a repeated‐measures anova model or paired t‐test when appropriate.ResultsThe total artificial pancreas acceptance questionnaire score at the end of the artificial pancreas period was 69.1 (sd 14.7; 95% CI 63.5, 74.7), indicating a positive attitude towards the artificial pancreas. No significant differences were found among the scores at baseline, end of sensor‐augmented pump therapy period or end of the artificial pancreas period with regard to fear of hypoglycaemia [28.2 (sd 17.5), 23.5 (sd 16.6) and 23.5 (sd 16.7), respectively; P = 0.099] or diabetes treatment satisfaction [29.0 (sd 3.9), 28.2 (sd 5.2) and 28.0 (sd 7.1), respectively; P = 0.43]. Themes frequently mentioned in the interviews were ‘positive effects at work’, ‘improved blood glucose’, ‘fewer worries about blood glucose’, but also ‘frequent alarms’, ‘technological issues’ and ‘demand for an all‐in‐one device’.ConclusionsThe psychological outcomes of artificial pancreas and sensor‐augmented pump therapy were similar. Current artificial pancreas technology is promising but user concerns should be taken into account to ensure utility of these systems.

Best friend or spy: a qualitative meta‐synthesis on the impact of continuous glucose monitoring on life with Type 1 diabetes

“…When the initial search was repeated with ‘qualitative’ as the refining search term, 13 articles were found, reduced to 10 research based articles, and 7 selected for further review. Search 2 and 3 combined yielded a total of nine articles included in this meta‐synthesis .…”

Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

“…Thirty-two percent of adult users in the USA who discontinued CGMs reported alarms as a primary reason for discontinuation [19]. Individuals with T1D also report concerns related to CGMs alarming at inconvenient times or causing unwanted attention to T1D at school, work, or personal settings and disturbing sleep [69, 77, 80]. While the frequency of alerts may be a nuisance in itself, it is also likely that alerts due to inaccurate readings cause additional frustration [19].…”

The impact of using a closed‐loop system on food choices and eating practices among people with Type 1 diabetes: a qualitative study involving adults, teenagers and parents

“…As is typical in studies investigating use of closed-loop technology, our sample was skewed towards educated and highly motivated individuals [4,6,7], which might limit the generalizability of our findings. An additional strength is our flexible, open-ended approach, as this enabled us to identify erstwhile unrecognized benefits and unintended consequences arising from using the closed-loop.…”

“…These systems need varying levels of user input, with most requiring users to count carbohydrates and announce this information prior to snacking or eating a meal [1]. While studies have previously consulted users of closed-loop systems, these have often focused on experiences of overnight systems [4][5][6][7][8][9] and/or systems used for very short periods (typically ≤5 days) in supervised environments [10][11][12], with none focusing specifically on how the use of a closed-loop might affect users' dietary practices. Specifically, it has been hypothesized that the use of a closed-loop may result in a transition from what has been termed 'restrained' to 'nonrestrained' eating behaviour, prompting calls for further research [3].…”