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Closing the loop overnight at home setting: psychosocial impact for adolescents with type 1 diabetes and their parents
  1. Katharine D Barnard1,
  2. Tim Wysocki2,
  3. Janet M Allen3,4,
  4. Daniela Elleri3,4,
  5. Hood Thabit4,
  6. Lalantha Leelarathna4,
  7. Arti Gulati4,
  8. Marianna Nodale4,
  9. David B Dunger3,
  10. Tannaze Tinati5,
  11. Roman Hovorka3,4
  1. 1Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
  3. 3Department of Paediatrics, University of Cambridge, Cambridge, UK
  4. 4Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
  5. 5MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  1. Correspondence to Dr Katharine Barnard; k.barnard{at}southampton.ac.uk

Abstract

Objective To explore the experiences of adolescents with type 1 diabetes mellitus (T1DM) and their parents taking part in an overnight closed loop study at home, using qualitative and quantitative research methods.

Research design and methods Adolescents aged 12–18 years on insulin pump therapy were recruited to a pilot closed loop study in the home setting. Following training on the use of a study insulin pump and continuous glucose monitoring (CGM), participants were randomized to receive either real-time CGM combined with overnight closed loop or real-time CGM alone followed by the alternative treatment for an additional 21 days with a 2–3-week washout period in between study arms. Semistructured interviews were performed to explore participants’ perceptions of the impact of the closed loop technology. At study entry and again at the end of each 21-day crossover arm of the trial, participants completed the Diabetes Technology Questionnaire (DTQ) and Hypoglycemia Fear Survey (HFS; also completed by parents).

Results 15 adolescents and 13 parents were interviewed. Key positive themes included reassurance/peace of mind, confidence, ‘time off’ from diabetes demands, safety, and improved diabetes control. Key negative themes included difficulties with calibration, alarms, and size of the devices. DTQ results reflected these findings. HFS scores were mixed.

Conclusions Closed loop insulin delivery represents cutting-edge technology in the treatment of T1DM. Results indicate that the psychological and physical benefits of the closed loop system outweighed the practical challenges reported. Further research from longitudinal studies is required to determine the long-term psychosocial benefit of the closed loop technology.

  • Adolescent Diabetes
  • Artificial Pancreas
  • Psychosocial Factors
  • Type 1

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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