The impact of using a closed‐loop system on food choices and eating practices among people with Type 1 diabetes: a qualitative study involving adults, teenagers and parents

Abstract

Aims We explored whether, how and why moving onto and using a hybrid day‐and‐night closed‐loop system affected people's food choices and dietary practices to better understand the impact of this technology on everyday life and inform recommendations for training and support given to future users. Methods Twenty‐four adults, adolescents and parents were interviewed before commencing use of the closed‐loop system and following its 3‐month use. Data were analysed thematically and longitudinally. Results While participants described preparing and/or eating similar meals to those consumed prior to using a closed‐loop, many described feeling more normal and less burdened by diabetes in dietary situations. Individuals also noted how the use of this technology could lead to deskilling (less precise carbohydrate counting) and less healthy eating (increased snacking and portion sizes and consumption of fatty, energy‐dense foods) because of the perceived ability of the system to deal with errors in carbohydrate counting and address small rises in blood glucose without a corrective dose needing to be administered. Conclusions While there may be quality‐of‐life benefits to using a closed‐loop, individuals might benefit from additional nutritional and behavioural education to help promote healthy eating. Refresher training in carbohydrate counting may also be necessary to help ensure that users are able to undertake diabetes management in situations where the technology might fail or that they take a break from using it.

Health professionals' views about who would benefit from using a closed‐loop system: a qualitative study

“…This approach helped to ensure that the discussion remained relevant to addressing the study's aims while also affording flexibility for interviewees to raise issues they perceived as salient, including those unforeseen at the study outset. The study was guided by an epistemological position, informed by previous work and the literature on the evaluation of complex (health) interventions , which recognizes that there may be unanticipated consequences to introducing new diabetes technologies . This position partly informed our decision to use topic guides rather than structured interview schedules, to allow (unanticipated) findings to emerge from the data.…”

“…To support successful rollout in routine clinical care, it is vital to understand how people perceive and engage with this technology. To date, studies have overwhelmingly focused on users and/or family members . Health professionals' perspectives have been surprisingly neglected despite their pivotal role as gatekeepers to new diabetes technologies .…”

What Training, Support, and Resourcing Do Health Professionals Need to Support People Using a Closed-Loop System? A Qualitative Interview Study with Health Professionals Involved in the Closed Loop from Onset in Type 1 Diabetes (CLOuD) Trial

“…Our epistemological position was informed by the literature on the evaluation of complex health interventions 16 as well as earlier work, which has highlighted how unexpected issues, benefits, and challenges may arise from introducing and using new diabetes technologies. 12,13…”

“…To date, most studies have focused on the experiences of people with type 1 diabetes and/or their family members when using closed-loop systems. [3][4][5][6][7][8][9][10][11][12][13] Health professionals' perspectives have only received limited attention, including their views about the training, support, and resourcing needed to support individuals using the technology in routine clinical care. This is an important omission, given the evidence that a key mediating factor in people's access to and experience of using diabetes technologies is professionals being appropriately trained and supported.…”

Ambassadors of hope, research pioneers and agents of change—individuals’ expectations and experiences of taking part in a randomised trial of an innovative health technology: longitudinal qualitative study

“…A key aim of our interview study was to understand and explore how people used the closed-loop to support diabetes management in order to aid interpretation of trial outcomes and provide recommendations for training and support which could be given to future users to help promote optimal use of the technology [18, 19]. As part of this investigation, we explored people’s reasons for taking part in the trial as well as their actual experiences of using the closed-loop system during the trial.…”