Psychosocial Assessment of Artificial Pancreas (AP): Commentary and Review of Existing Measures and Their Applicability in AP Research

Barnard, Katharine; Hood, Korey K.; Weissberg‐Benchell, Jill; Aldred, Chris; Oliver, Nick; Laffel, Lori

doi:10.1089/dia.2014.0305

Cited by 42 publications

(51 citation statements)

References 37 publications

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“…7 The study showed one of these factors that may play an important role in consistent use of CGM, as the perception of Information Overload had a relevant negative effect on all key variables of TAM-CGM. Reduced complexity in the presentation of data may therefore facilitate CGM usability for some patients and thus improve user experience, possibly increasing adherence.…”

Section: Discussionmentioning

confidence: 87%

Continuous Glucose Monitoring in Type 1 Diabetes

Kubiak

2016

J Diabetes Sci Technol

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Background: Continuous glucose monitoring (CGM) patient systems have been shown to improve diabetes self-treatment when used consistently. The meaningful integration of this technology into everyday life, however, can vary greatly among CGM users and not all people with diabetes use CGM to its full potential. To address this issue, the study pursued 2 aims: first, to identify patient characteristics that underlie the acceptance of CGM in people with type 1 diabetes and, second, to examine the effects of different levels of experience with CGM use. Methods: Guided by a model based on the technology acceptance model (TAM), structural equation modeling (SEM) was employed to model the patient characteristics as predictors of CGM acceptance. In all, 111 participants (60.4% female, mean = 37.6 years, SD = 11.2) participated in a web-based survey; 40 were current CGM users, 18 were former users and 53 had no experience with CGM systems. Results: In general, participants evaluated CGM positively; however, the feeling of information overload represented a major barrier to the sustained use of CGM, while perceptions of usefulness and ease of use constituted incentives for using this technology. Moreover, patients without CGM experience imagined more information overload than current users reported. Current users showed more intention to use CGM than former users. Conclusion: This study highlights the importance of CGM user experience for the effective use of this technology.

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Section: Discussionmentioning

confidence: 87%

Continuous Glucose Monitoring in Type 1 Diabetes

Kubiak

2016

J Diabetes Sci Technol

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“…As medical devices like the AP increase in complexity to provide patients with personalized treatment, their number of loopholes and vulnerabilities also increase [23, 45]. For example, the dual-hormone AP includes an additional infusion system for glucagon and promises to further reduce hypoglycaemic events in comparison to single-hormone systems [21, 46], but the addition of glucagon may amplify security concerns.…”

Section: Domains Of Ethical Issuesmentioning

confidence: 99%

“…In a study exploring adolescent and parent perceptions of the AP following a three-week trial at home, participants reported feeling greater assurance in their ability to manage their T1D, as well as a sense of safety and peacefulness [22]. In two other studies, participants reported similar psychosocial benefits, in addition to improved daily functioning, sleep, and overall quality of life, most likely due to a relief from some key components of T1D care [23, 24]. In return, an AP user must be willing to wear at all times all the pieces of the AP and still needs to rotate the sensor and infusion sites [24].…”

Section: Introductionmentioning

confidence: 99%

A critical review and analysis of ethical issues associated with the artificial pancreas

Quintal

Messier

Rabasa‐Lhoret

et al. 2019

Diabetes & Metabolism

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The artificial pancreas combines a hormone infusion pump with a continuous glucose monitoring device, supported by a dosing algorithm currently installed on the pump. It allows for dynamic infusions of insulin (and possibly other hormones such as glucagon) tailored to patient needs. For patients with type 1 diabetes the artificial pancreas has been shown to prevent more effectively hypoglycaemic events and hyperglycaemia than insulin pump therapy and has the potential to simplify care. However, the potential ethical issues associated with the upcoming integration of the artificial pancreas into clinical practice have not yet been discussed. Our objective was to identify and articulate ethical issues associated with artificial pancreas use for patients, healthcare professionals, industry and policymakers. We performed a literature review to identify clinical, psychosocial and technical issues raised by the artificial pancreas and subsequently analysed them through a common bioethics framework. We identified five sensitive domains of ethical issues. Patient confidentiality and safety can be jeopardized by the artificial pancreas' vulnerability to security breaches or unauthorized data sharing. Public and private coverage of the artificial pancreas could be cost-effective and warranted. Patient selection criteria need to ensure equitable access and sensitivity to patient-reported outcomes. Patient coaching and support by healthcare professionals or industry representatives could help foster realistic expectations in patients. Finally, the artificial pancreas increases the visibility of diabetes and could generate issues related to personal identity and patient agency. The timely consideration of these issues will optimize the technological development and clinical uptake of the artificial pancreas.

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“…In addition to conventional endpoints such as glycated hemoglobin, quality of life is to be included to assess burden of disease management and hypoglycemia. A concert effort is underway to develop measures that more adequately capture the role of human and psychological factors play in the uptake and efficient use of closed-loop systems [76,77]. …”

Section: Expert Opinionmentioning

confidence: 99%

Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

Tauschmann

Hovorka

2017

Expert Opinion on Drug Delivery

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Introduction: Nocturnal glucose control remains challenging in children and adolescents with type 1 diabetes due to highly variable overnight insulin requirements. The issue may be addressed by glucose responsive insulin delivery based on real-time continuous glucose measurements.Areas covered: This review outlines recent developments of glucose responsive insulin delivery systems from a paediatric perspective. We cover threshold-based suspend application, predictive low glucose suspend, and more advanced single hormone and dual-hormone closed-loop systems. Approaches are evaluated in relation to nocturnal glucose control particularly during outpatient randomised controlled trials.Expert opinion: Significant progress translating research from controlled clinical centre settings to free-living unsupervised home studies have been achieved over the past decade. Nocturnal glycaemic control can be improved whilst reducing the risk of hypoglycaemia with closed-loop systems. Following the US regulatory approval of the first hybrid closed-loop system in non-paediatric population, large multinational closed-loop clinical trials and pivotal studies including paediatric populations are underway or in preparation to facilitate the use of closed-loop systems in clinical practice.

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Psychosocial Assessment of Artificial Pancreas (AP): Commentary and Review of Existing Measures and Their Applicability in AP Research

Abstract: A better understanding of the psychosocial side of AP systems and the extent to which human factors play a role in the uptake and efficient use of these systems will ultimately lead to the most benefit for people with diabetes.

Cited by 42 publications

References 37 publications

Continuous Glucose Monitoring in Type 1 Diabetes

Continuous Glucose Monitoring in Type 1 Diabetes

A critical review and analysis of ethical issues associated with the artificial pancreas

Insulin delivery and nocturnal glucose control in children and adolescents with type 1 diabetes

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