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

Abstract

Background: We explored health professionals' views about the training, support, and resourcing needed to support people using closed-loop technology in routine clinical care to help inform the development of formal guidance. Methods: Interviews were conducted with health professionals (n = 22) delivering the Closed Loop from Onset in Type 1 Diabetes (CLOuD) trial after they had ‡6 months' experience of supporting participants using a closed-loop system. Data were analyzed descriptively. Results: Interviewees described how, compared with other insulin regimens, teaching and supporting individuals to use a closed-loop system could be initially more time-consuming. However, they also noted that after an initial adjustment period, users had less need for initiating contact with the clinical team compared with people using pumps or multiple daily injections. Interviewees highlighted how a lessened need for ad hoc clinical input could result in new challenges; specifically, they had fewer opportunities to reinforce users' diabetes knowledge and skills and detect potential psychosocial problems. They also observed heightened anxiety among some parents due to the constant availability of data and unrealistic expectations about the system's capabilities. Interviewees noted that all local diabetes teams should be empowered to deliver closed-loop system care, but stressed that

Real-World Patient-Reported Outcomes and Glycemic Results with Initiation of Control-IQ Technology

“… 21 A considerable amount of literature has been developed on how to help patients with diabetes use AID systems, particularly related to keeping closed-loop automation active. 22 , 23 Control-IQ technology has only one reason for automation to cease (loss of CGM connectivity for 20 or more minutes), and automatically resumes automation as soon as valid CGM values are received with no need for the user to switch on or activate automation in any way. PROs suggesting high trust in the system related to CGM accuracy and efficient connectivity to the CGM as valuable features matches our real-world results showing 96% use of closed-loop automation.…”

COVID-19 and Diabetes: Could Diabetes Technology Research Help Pave the Way for Remote Healthcare?

“…They enable greater patient independence and quality of life, reduce the need for healthcare input, simplify data sharing, and improve glycemic outcomes. 5-8 As “routine” healthcare is turned on its head, these technologies can ease the burden on both patients and healthcare providers by facilitating remote healthcare delivery.…”

“…After an initial training period, closed-loop systems require less healthcare provider input than standard therapy. 5 Easy data viewing on handheld devices empowers patients to make independent and frequent changes to their insulin dosing as well as decreasing diabetes distress, 10,11 and it allows healthcare providers to quickly access data when giving advice. The nature of the technology we research has enabled a relatively seamless transition to remote support during the pandemic with study participants continuing to feel well supported clinically.…”

AiDAPT: automated insulin delivery amongst pregnant women with type 1 diabetes: a multicentre randomized controlled trial – study protocol

“…In keeping with other investigations of user and health professional experiences of closed-loop technology [ 28 – 30 ], a flexible, open-ended approach will be used, allowing participants to raise issues they consider salient, including those unforeseen at the study outset. Interviews will be informed by topic guides, developed in light of earlier qualitative investigations of closed-loop system use [ 28 – 30 ] and inputs from the co-investigator team. Data collection and analysis will take place concurrently so that findings identified in early interviews can inform the topics explored in later accounts.…”