Artificial pancreas use viewed positively by users and caregivers
medwireNews: Daytime use of a day-and-night hybrid artificial pancreas system has a positive impact on the lives of users and their caregivers, show results of a longitudinal qualitative study.
The study included 10 adults and five adolescents (aged 13–17 years) with type 1 diabetes who were initiating use of the FlorenceM closed-loop system, which incorporates the University of Cambridge algorithm (version 0.3.46) on a Galaxy S4 smartphone (Samsung, South Korea), as well as nine parents of the users.
Participants of the APCam11 trial were interviewed in-depth before using the hybrid day-and-night closed-loop system, which was combined with a pump suspend feature, and again 3 months later.
Prior to use of the device, participants expected to achieve better and more stable glycemic control, but they felt that they would still need to be aware of, and treat, hypoglycemia.
Patients also initially believed that they would not be able to completely trust the system and would need to regularly check its function, report Julia Lawton (University of Edinburgh, UK) and colleagues.
This assumption was confirmed at the follow-up interview, where participants said that they frequently reviewed the system’s graphs over several weeks for reassurance that it was working correctly. However, the level of checking reduced as the participants gained trust in the technology and as they began to fully understand how the algorithm works.
This indicates that users could “benefit from knowing that the system takes several days to calibrate to their insulin requirements to help avoid panic, worry, and/or their taking action which might compromise its learning,” Lawton et al write in Diabetes Technology & Therapeutics.
The researchers say that using the closed-loop system reduced the burden of diabetes self-management among participants, which in turn improved how they felt about having diabetes. In addition, parents said that relationships with their children improved because they no longer needed to constantly remind their children to undertake self-management tasks such as testing blood glucose.
Participants also described a number of clinical and quality-of-life benefits “because the closed-loop system had been able to provide a level of responsiveness which had extended beyond their own human capabilities […] especially when they were working or distracted by other responsibilities during the day,” the team notes.
Such benefits included the ability to lead a more spontaneous and active life, with parents reporting that they were able to give their children more freedom because confidence in their child’s safety had been increased.
In contrast to initial perceptions, the majority of participants reported that they continued to take an active role in their diabetes management because of the additional data they had access to.
Indeed, many patients said they wanted more opportunities to collaborate with the closed-loop system to optimize its effectiveness, for example by being able to communicate information about atypical days or add details of the intensity of any physical activity they were planning.
In general, participants felt that the closed-loop system was “intuitive, self-explanatory, and easy to use,” with input from staff at participating sites declining after the first month of use. After this point, participants felt that their need for staff support “would be no greater than that required when using a pump,” say Lawton and co-investigators.
They conclude: “By exploring participants’ experiences of using a hybrid day-and-night closed-loop system during the day we have shown that the perceived glycemic and quality-of-life benefits of overnight systems extend into daytime use.”
By Laura Cowen
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