Situational Awareness and Proactive Engagement Predict Higher Time in Range in Adolescents and Young Adults Using Hybrid Closed-Loop

Abstract

Background. Adolescents and young adults with type 1 diabetes have high HbA1c levels and often struggle with self-management behaviors and attention to diabetes care. Hybrid closed-loop systems (HCL) like the t:slim X2 with Control-IQ technology (Control-IQ) can help improve glycemic control. The purpose of this study is to assess adolescents’ situational awareness of their glucose control and engagement with the Control-IQ system to determine significant factors in daily glycemic control. Methods. Adolescents (15–25 years) using Control-IQ participated in a 2-week prospective study, gathering detailed information about Control-IQ system engagements (boluses, alerts, and so on) and asking the participants’ age and gender about their awareness of glucose levels 2-3 times/day without checking. Mixed models assessed which behaviors and awareness items correlated with time in range (TIR, 70–180 mg/dl, 3.9–10.0 mmol/L). Results. Eighteen adolescents/young adults (mean age 18 ± 1.86 years and 86% White non-Hispanic) completed the study. Situational awareness of glucose levels did not correlate with time since the last glucose check ( p = 0.8 ). In multivariable modeling, lower TIR was predicted on days when adolescents underestimated their glucose levels (r = −0.22), received more CGM alerts (r = −0.31), and had more pump engagements (r = −0.27). A higher TIR was predicted when adolescents responded to CGM alerts (r = 0.20) and entered carbohydrates into the bolus calculator (r = 0.49). Conclusion. Situational awareness is an independent predictor of TIR and may provide insight into patterns of attention and focus that could positively influence glycemic outcomes in adolescents. Proactive engagements predict better TIR, whereas reactive engagement predicted lower TIR. Future interventions could be designed to train users to develop awareness and expertise in effective diabetes self-management.

“Obviously, Nothing's Gonna Happen in Five Minutes”: How Adolescents and Young Adults Infrastructure Resources to Learn Type 1 Diabetes Management

“…Adolescents and young adults (AYAs, aged 15–25) with T1D exhibit the highest average HbA1c levels compared to other age groups [ 31 ] and share distinct developmental, cognitive, and psychological transitions [ 1 , 16 , 38 , 52 ]. Common challenges with effective self-management may be exacerbated by the unique transitions and hurdles encountered by AYAs.…”

“…Various aspects of diabetes technologies, as mentioned in Section 2.1 , support AYAs’ self-management with T1D (e.g., [ 52 ]). Studies have shown that hybrid closed-loop systems can improve patients’ active or passive awareness of hypoglycemia and hyperglycemia (e.g., both during waking hours and during sleep [ 29 , 39 , 47 , 55 ]).…”

“…Studies have shown that hybrid closed-loop systems can improve patients’ active or passive awareness of hypoglycemia and hyperglycemia (e.g., both during waking hours and during sleep [ 29 , 39 , 47 , 55 ]). Recently, Messer and colleagues underscored the importance of situational awareness in signaling AYAs’ proactive blood glucose management in the context of hybrid closed-loop system usage, associated with improved glycemic control compared to reactive management [ 52 ]. However, the specific constitution of this situational awareness remains unclear.…”

“…Consequently, young patients also seek awareness support from other aspects of their daily lives, such as bodily cues [ 19 ] or self-experience [ 17 ]. Taken together, this personalized combination of technological and non-technological resources and the AYAs’ relations to them that are embedded in different temporal and social contexts constitute a health infrastructure that—when working well—invisibly supports the everyday routines of self-care [ 61 , 65 , 66 ] and facilitates learning of proactive management techniques [ 52 ]. In this case, the situational awareness gained by these infrastructures’ use facilitates proactive blood glucose management, leading to improved overall glycemic control [ 52 ].…”

“…Taken together, this personalized combination of technological and non-technological resources and the AYAs’ relations to them that are embedded in different temporal and social contexts constitute a health infrastructure that—when working well—invisibly supports the everyday routines of self-care [ 61 , 65 , 66 ] and facilitates learning of proactive management techniques [ 52 ]. In this case, the situational awareness gained by these infrastructures’ use facilitates proactive blood glucose management, leading to improved overall glycemic control [ 52 ]. Thus, it is important to understand how young people assemble and employ both technological and non-technological resources when learning self-management routines amid disruptions to achieve optimal glycemic control.…”