Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

Forlenza, Gregory P.; Messer, Laurel H.; Berget, Cari; Wadwa, R. Paul; Driscoll, Kimberly A.

doi:10.1007/s11892-018-1078-1

Cited by 35 publications

(28 citation statements)

References 102 publications

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“…The youth in this real‐world study experienced nearly one Auto Mode exit per day, calibrated their sensor 2‐3 times per day, and checked blood glucose levels 5‐6 times per day. This is consistent with Faulds and colleagues' study, which reported that adults using 670G in the first 3 months calibrated their sensor 3.2 times/day and checked BG an average of 6.5 times/day . In an era when many individuals with type 1 diabetes are using factory calibrated CGM systems, requiring BG checks and sensor calibrations may be too high a burden for sustained use of HCL.…”

Section: Discussionsupporting

confidence: 88%

“…Youth may require substantial clinical support to overcome barriers in using CGM to ensure success in sustaining HCL use. Body image concerns, financial barriers, skin irritation, alarm fatigue, technical problems, and perceived lack of trust in the CGM glucose values are commonly cited barriers to CGM use in youth and young adults . It is important that health care providers and educators assess individual barriers to CGM use and provide psychosocial and educational support to assist youth in overcoming these barriers.…”

Section: Discussionmentioning

confidence: 99%

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Six months of hybrid closed loop in the real‐world: An evaluation of children and young adults using the 670G system

Berget¹,

Messer²,

et al. 2020

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Objective: To describe glycemic and psychosocial outcomes in youth with type 1 diabetes using a hybrid closed loop (HCL) system. Subjects: Youth with type 1 diabetes (2-25 years) starting the 670G HCL system for their diabetes care were enrolled in an observational study. Methods: Prospective data collection occurred during routine clinical care and included glycemic variables (sensor time in range [70-180 mg/dL], HbA1c), and psychosocial variables (Hypoglycemia Fear Survey [HFS]; Problem Areas in Diabetes [PAID]). Mixed models were used to analyze change across time.Results: Ninety-two youth (mean age 15.7 ± 3.6 years, 50% female, HbA1c 8.8% ± 1.8%) started HCL for their diabetes care. Youth used Auto Mode 65.5% ± 3.0% of the time at month 1, which decreased to 51.2% ± 3.4% at month 6 (P = .001). Sensor time in range increased from 50.7% ± 1.8% at baseline to 56.9% ± 2.1% at 6 months (P = .007). HbA1c decreased from 8.7% ± 0.2% at baseline to 8.4% ± 0.2% after 6 months of use (P ≤ .0001), with the greatest HbA1c decline in participants with high baseline HbA1c. Increased percent time in auto mode was associated with lower HbA1c (P = .02). Thirty percent of youth discontinued HCL in the first 6 months of use. There were no changes in the HFS or PAID scores across time.Conclusions: HCL use is associated with improved glycemic control and no change in psychosocial outcomes in this clinical sample. The decline in HCL use across time suggests that youth experience barriers in sustaining use of HCL. Further research is needed to understand reasons for HCL discontinuation and determine intervention strategies.pediatrics, artificial pancreas, automated insulin delivery, continuous glucose monitor The use of diabetes technology is a promising treatment strategy to improve diabetes outcomes in youth. Use of insulin pumps and continuous glucose monitors (CGM) are associated with reduction in HbA1c, both when used separately and together. 7 The most advanced technology currently available for diabetes care is a hybrid closed loop (HCL) insulin delivery system. HCL technology automates basal insulin delivery in response to CGM glucose trends while users deliver bolus doses for carbohydrate consumption. The MiniMed 670G is the first HCL device to be commercially available, which consists of the 670G insulin pump and the Guardian 3 CGM.The 670G operates in two modes, both as a standard insulin pump ("Manual Mode"), and as HCL ("Auto Mode"). 8 When using the 670G system in Auto Mode, the basal insulin delivery is calculated every 5 min by the pump's HCL algorithm, based on sensor glucose data. 9 To maintain Auto Mode use, the user must wear the CGM consistently, calibrate the CGM sensor at least twice per day, and respond to alerts in a timely manner. The system exits users from Auto Mode to Manual Mode if: (a) there is prolonged hyperglycemia (ie, sensor glucose >250 mg/dL for 3 h or >300 mg/dL for 1 h); (b) the pump has delivered a minimum or maximum insulin rate for 1-3 h; or (c) sensor glucose data are missing or inaccurate...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Six months of hybrid closed loop in the real‐world: An evaluation of children and young adults using the 670G system

Berget¹,

Messer²,

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Other factors in addition to baseline HbA1c may also predict HCL discontinuation but were not detected in this current study. Diabetes distress, for example, has been shown previously to be associated with poorer T1D self‐management practices and glycemic control in youth with T1D, and should be further considered in light of the workload and alert fatigue described by HCL discontinuers. Other psychological factors may yield further insight into discontinuation of HCL, including self‐efficacy for diabetes care, or perceptions and expectations of HCL systems .…”

Section: Discussionmentioning

confidence: 99%

“…Participants then completed the quantitative portion, which consisted of 22 equally weighted possible burdens or problems with diabetes technology that the users and parents rated on a visual analog scale (VAS) developed by the study team. The scale included burdens described from the literature on device barriers with additional content added based on the study group's clinical experience and specific concerns with HCL. The survey prompt stated: “For the following questions, move the slider to indicate how much of a burden or problem the following have been for you when using the HCL device.…”

Section: Methodsmentioning

confidence: 99%

“…The reasons for HCL discontinuation are not well documented, with one report indicating sensor issues and difficulty obtaining supplies as primary reasons . Other general diabetes technology barriers also likely apply, such as the hassle of wearing devices and too many alerts . Research is needed to identify risk factors for HCL discontinuation and to understand the reasons for its discontinuation to better inform prescribing practices and clinician support.…”

Section: Introductionmentioning

confidence: 99%

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Real world hybrid closed‐loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months

et al. 2020

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Objective: To describe predictors of hybrid closed loop (HCL) discontinuation and perceived barriers to use in youth with type 1 diabetes.Subjects: Youth with type 1 diabetes (eligible age 2-25 y; recruited age 8-25 y) who initiated the Minimed 670G HCL system were followed prospectively for 6 mo in an observational study.Research Design and Methods: Demographic, glycemic (time-in-range, HbA1c), and psychosocial variables [Hypoglycemia Fear Survey (HFS); Problem Areas in Diabetes (PAID)] were collected for all participants. Participants who discontinued HCL (<10% HCL use at clinical visit) completed a questionnaire on perceived barriers to HCL use.Results: Ninety-two youth (15.7 ± 3.6 y, HbA1c 8.8 ± 1.3%, 50% female) initiated HCL, and 28 (30%) discontinued HCL, with the majority (64%) discontinuing between 3 and 6 mo after HCL start. Baseline HbA1c predicted discontinuation (P = .026) with the odds of discontinuing 2.7 times higher (95% CI: 1.123, 6.283) for each 1% increase in baseline HbA1c. Youth who discontinued HCL rated difficulty with calibrations, number of alarms, and too much time needed to make the system work as the most problematic aspects of HCL. Qualitatively derived themes included technological difficulties (error alerts, not working correctly), too much work (calibrations, fingersticks), alarms, disappointment in glycemic control, and expense (cited by parents).Conclusions: Youth with higher HbA1c are at greater risk for discontinuing HCL than youth with lower HbA1c, and should be the target of new interventions to support device use. The primary reasons for discontinuing HCL relate to the workload required to use HCL. K E Y W O R D Sartificial pancreas, continuous glucose monitor, insulin pump, hybrid closed loop, pediatrics, type 1 diabetes Type 1 diabetes (T1D), typically diagnosed in childhood 1,2 requires lifelong replacement of exogenous insulin, and monitoring of glucose levels to minimize hypoglycemia and hyperglycemia. 3 Long-term consequences of suboptimal glycemic control include both microvascular and macrovascular complications that increase morbidity and mortality for individuals with T1D. 3 Sub-optimal glycemic control also increases risk of emergent complications such as hypoglycemic seizures and loss of consciousness, and diabetic ketoacidosis or diabetic coma. 4,5 The T1D Exchange Registry recently showed that in the United States only 21% of adults and 17% of youth with T1D meet hemoglobin A1c (HbA1c) goals set forth by the American Diabetes Association, signifying the need for improvements in treatment and care of T1D. 6

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An Ethical Perspective on the Social Value of Cell-Based Technologies in Type 1 Diabetes

de Jongh,

Bunnik

2023

Pluripotent Stem Cell Therapy for Diabetes

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Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field

Cited by 35 publications

References 102 publications

Six months of hybrid closed loop in the real‐world: An evaluation of children and young adults using the 670G system

Six months of hybrid closed loop in the real‐world: An evaluation of children and young adults using the 670G system

Real world hybrid closed‐loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months

An Ethical Perspective on the Social Value of Cell-Based Technologies in Type 1 Diabetes

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