Greatest beneficiaries of closed-loop systems not always as HCPs assume
medwireNews: Healthcare professionals (HCPs) can make false assumptions about which children with type 1 diabetes will gain most from closed-loop insulin delivery, risking children who could potentially benefit missing out, research suggests.
“[O]ur findings suggest there is a danger that, in routine clinical situations, health professionals’ attitudes and biases could result in some individuals, who might benefit from closed-loop technology, not being given the opportunity to use it,” write Julia Lawton (University of Edinburgh, UK) and study co-authors.
Such “informal rationing” has previously been reported for diabetes technologies such as insulin pumps, they note.
The team interviewed seven doctors, nine diabetes specialist nurses, and six research nurses participating in the ongoing Closed Loop from Onset in type 1 Diabetes (CLOuD) trial, which involves children aged 10–16 years with newly diagnosed type 1 diabetes.
The HCPs admitted to having had strong preconceptions about who would stand to gain most from the closed-loop technology, believing the ideal candidate to be someone with a strong interest in technology, the intellectual ability to fully understand the system, and with a close-knit and supportive family.
However, access to the system used in the CLOuD trial was determined by the inclusion and exclusion criteria, and by the randomization process (to artificial pancreas or multiple daily injections), allowing access to a broad range of children.
Thus the HCPs’ preconceptions “were challenged by observing individuals using the technology in ways they had not anticipated,” write the researchers in Diabetic Medicine.
For example, they observed that some people who were “more academically minded” or with a medical background had “over-interacted with the system,” inhibiting the algorithm (the Cambridge algorithm) from optimally adapting to the individual’s metabolic needs and compromising glucose control.
By contrast, families who were content to follow the guidelines laid down by the clinical trial HCPs often had better outcomes.
The HCPs also concluded that they could not prejudge family outcomes; even where they felt they had correctly assessed family dynamics, the introduction of a closed-loop system could act as a catalyst for positive change.
Given their lack of ability to predict how children would respond to using an artificial pancreas system, the HCPs “suggested that, ideally all individuals should be given a chance to try a closed-loop system,” say the researchers.
They also suggested the systems be given on a trial basis of several months, and that their use be regularly reviewed, noting that closed-loop delivery can result in users becoming complacent about tasks like giving insulin boluses for snacks.
The HCPs stressed the need for clinical guidelines “to inform potentially difficult decisions about who should be prioritized in settings such as the [UK National Health Service], where budgetary constraints may limit access to new diabetes technologies.”
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