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Published Online: 1 July 2017

“It Is Definitely a Game Changer”: A Qualitative Study of Experiences with In-home Overnight Closed-Loop Technology Among Adults with Type 1 Diabetes

Publication: Diabetes Technology & Therapeutics
Volume 19, Issue Number 7

Abstract

Background: This qualitative study explored trial participants' experiences of four nights of in-home closed loop.
Methods: Sixteen adults with type 1 diabetes, who completed a randomized crossover trial, were interviewed after four consecutive nights of closed-loop. Interviews were audio recorded, transcribed, and analyzed with a coding framework developed to identify the main themes.
Results: Participants had a mean age of 42 ± 10 years, nine were women; mean diabetes duration was 27 ± 7 years, and all were using insulin pumps. Overall, first impressions were positive. Participants found closed-loop easy to use and understand. Most experienced more stable overnight glucose levels, although for some these were similar to usual care or higher than they expected. Compared with their usual treatment, they noticed the proactive nature of the closed-loop, being able to predict trends and deliver micro amounts of insulin. Most reported technical glitches or inconveniences during one or more nights, such as transmission problems, problematic connectivity between devices, ongoing alarms despite addressing low glucose levels, and sensor inaccuracy. Remote monitoring by the trial team and their own hypoglycemic awareness contributed to feelings of trust and safety. Although rare, safety concerns were raised, related to feeling unsure whether the system would respond in time to falling glucose levels.
Conclusions: This study provides relevant insights for implementation of closed-loop in the real world. For people with diabetes who are less familiar with technology, remote monitoring for the first few days may provide reassurance, strengthen their trust/skills, and make closed-loop an acceptable option for more people with type 1 diabetes.

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Published In

cover image Diabetes Technology & Therapeutics
Diabetes Technology & Therapeutics
Volume 19Issue Number 7July 2017
Pages: 410 - 416
PubMed: 28537437

History

Published in print: July 2017
Published online: 1 July 2017
Published ahead of print: 24 May 2017

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Christel Hendrieckx, PhD
School of Psychology, Deakin University, Geelong, Victoria, Australia.
The Australian Center for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
Lucinda A. Poole, BAppSc (Psych) (Hons)
School of Psychology, Deakin University, Geelong, Victoria, Australia.
The Australian Center for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
Amin Sharifi, MD
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Dilshani Jayawardene, MBBS
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Margaret M. Loh, RN
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Jodie C. Horsburgh, RN
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Leon A. Bach, PhD
Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia.
Department of Medicine, Monash University, Melbourne, Victoria, Australia.
Peter G. Colman, MD
Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Kavita Kumareswaran, PhD
Department of Endocrinology and Diabetes, Alfred Hospital, Melbourne, Victoria, Australia.
Alicia J. Jenkins, MD
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.
NHMRC Clinical Trials Center, University of Sydney, Camperdown, New South Wales, Australia.
Richard J. MacIsaac, PhD
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Glenn M. Ward, PhD
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Benyamin Grosman, PhD
Medtronic Diabetes, Northridge, California.
Anirban Roy, PhD
Medtronic Diabetes, Northridge, California.
David N. O'Neal, MD
Department of Endocrinology and Diabetes, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Jane Speight, PhD
School of Psychology, Deakin University, Geelong, Victoria, Australia.
The Australian Center for Behavioral Research in Diabetes, Diabetes Victoria, Melbourne, Victoria, Australia.
AHP Research, Hornchurch, Essex, United Kingdom.

Notes

Author for correspondence:Christel Hendrieckx, PhDThe Australian Centre for Behavioural Research in DiabetesDiabetes Victoria570 Elizabeth StreetMelbourneVictoria 3000Australia
E-mail: [email protected]

Author Disclosure Statement

C.H., L.A.P., A.S., D.J., M.M.L., J.C.H., L.A.B., K.K., and G.M.W. declare no competing financial interests. P.G.C. has received lecturing fees from Medtronic. B.G. and A.R. are employees and stockholders of Medtronic. A.J.J. is on an advisory board for Medtronic Diabetes and Abbott Diabetes and has received honoraria from Medtronic and Sanofi. R.J.M. reports travel support from Novo Nordisk, Sanofi, and Boehringer Ingelheim; is a member of an advisory board for Boehringer Ingelheim, and has received lecture fees from Bayer, Astra Zeneca, MSD, Novartis, Boehringer Ingelheim, and Novo Nordisk. J.S. is a member of the Accu-Chek advisory board for Roche Diabetes Care and has participated in an advisory board for Janssen Pharmaceuticals; her research group has received research support from Abbott Diabetes Care, Roche Diabetes Care, and Sanofi ANZ; and consultancy honoraria from Abbott Diabetes Care, Astra Zeneca, Roche Diabetes Care, and Sanofi ANZ. D.N.O. has been on an advisory board for Abbott Diabetes and has received speakers' fees and research support from Medtronic and Novo Nordisk.

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