Psychosocial impacts of hybrid closed‐loop systems in the management of diabetes: a review

Abstract

There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps. Recent studies have demonstrated that closed-loop systems offer significant benefit in terms of improved glycaemic control. However, less attention has been paid to the psychosocial impact on users of closed-loop systems. This article reviews recent research on psychosocial aspects of closed-loop usage in light of preceding research on user experience of currently available technologies such as insulin pumps and CGM sensors. The small, but growing body of research in this field reports generally positive user experience and a number of experienced benefits including: reassurance and reduced anxiety, improved sleep and confidence, and 'time off' from diabetes demands. However, these benefits are counterbalanced by important challenges, ranging from variable levels of trust to concerns about physical bulk, technical glitches and difficulties incorporating closed-loop systems into everyday life. Future research should explore psychosocial aspects of closed-loop usage in more diverse groups and with regard to clinicians, as well as users, to ensure that the clinical benefits of closed-loop systems are realized at scale in routine medical care.

Appearance of Do‐It‐Yourself closed‐loop systems to manage type 1 diabetes

“…Previous studies have suggested a reduction in psychosocial burden 10 and improved glycaemic control 11 with closed-loop systems. Similar benefits have been reported with OpenAPS, initially in 2016 12 and more recently this year at the 78th scientific sessions of the American Diabetes Association.…”

Reduced burden of diabetes and improved quality of life: Experiences from unrestricted day‐and‐night hybrid closed‐loop use in very young children with type 1 diabetes

“…The psychosocial benefits of closed‐loop have been explored in older children, adolescents, and adults but the impact of closed‐loop use in very young children with type 1 diabetes is yet to be assessed.…”

Who Should Access Closed-Loop Technology? A Qualitative Study of Clinician Attitudes in England

“…6 While highly specific to 670G systems, these data nevertheless echo previous psychosocial research reporting burdens as well as benefits for closed-loop users. 7 While 670G and (increasingly) home-made closed-loop systems are used by growing numbers of users, national and international eligibility guidelines have yet to be formulated. 8 Consequently, while the automated nature of closed-loop technology promises improved control for people with type 1 diabetes, debate continues regarding appropriate levels of closed-loop usage in mainstream care.…”