The process of incorporating insulin pumps into the everyday lives of people with Type 1 diabetes: A critical interpretive synthesis

Abstract

BackgroundInsulin pump therapy (IPT) is a technological advancement that has been developed to help people manage Type 1 diabetes (T1D). However, ways of managing diabetes requiring the implementation of health technologies bring new complexities and a need to understand the factors which enable people with T1D to incorporate a novel device. This new comprehension could provide an exemplar for people with long‐term conditions to incorporate new technologies more generally.ObjectiveTo determine what influences the incorporation, adaptation and use of IPT into the everyday lives of people living with diabetes.DesignCritical interpretive synthesis (CIS) using systematic searches undertaken in 7 electronic databases of literature, published 2008 onwards.ResultsA total of 4998 titles were identified, 274 abstracts reviewed, 39 full articles retrieved and 22 papers selected for analysis. Three themes emerged which were of relevance to the introduction and use of IPT; Tensions between expectations and experiences in adoption and early adaptation; Negotiation of responsibility and accessing support; Reflexivity, active experimentation and feedback.ConclusionsThis CIS builds on earlier reviews on lived experiences of IPT. Novel insights are offered through examination of the experiences of pump users from children through to adults, their families and health‐care professionals. Expectations of what the device can do to improve self‐management impacts on the early stages of adoption as the reality of the technology requires substantial thought and action. Areas for intervention to improve IPT incorporation include establishing who is responsible for management tasks of the device and enabling navigation to further means of support and resources.

Stratified users and technologies of empowerment: theorising social inequalities in the use and perception of diabetes self‐management technologies

“…by switching from insulin injection by needle to using an insulin pump) requires the user to learn new skills and competencies through active experimentation and self‐reflection (Reidy et al . ). The challenging, stratified and technological nature of diabetes care makes it an excellent case for studying the relationship between technological development, self‐management and health inequalities.…”

Diabetes Care During Hajj

“… The dosage of short- and intermediate-acting insulin may be reduced by 20% before and during prolonged walking routes [ 21 ]. For patients with T1DM, insulin pump therapy may be preferred for optimising glycaemic control during Hajj, as this therapy allows for flexibility during meals and minimises the risk of hypoglycaemia [ 43 ]. Patients must be advised to also pack injectable insulin in order to facilitate the switch to basal bolus regimen in case of pump failure [ 42 , 43 ].…”

“…For patients with T1DM, insulin pump therapy may be preferred for optimising glycaemic control during Hajj, as this therapy allows for flexibility during meals and minimises the risk of hypoglycaemia [ 43 ].…”

“…Patients must be advised to also pack injectable insulin in order to facilitate the switch to basal bolus regimen in case of pump failure [ 42 , 43 ].…”

A novel exploration of the support needs of people initiating insulin pump therapy using a social network approach: a longitudinal mixed‐methods study

“…There is a drive from policy makers to prioritising self‐management support in long‐term conditions and increased momentum from NHS England and diabetes voluntary organisations to consider the emotional well‐being of people with diabetes when promoting self‐management support . The need for self‐management support is heightened when new health technologies, such as insulin pump therapy in type 1 diabetes, are introduced, requiring renewed knowledge, confidence and resources . However, few diabetes support interventions explore or address improving self‐management abilities or engagement with health services together with social support networks, yet for people with long‐term conditions, social networks can provide an important means of mobilising, mediating and accessing support for health and well‐being .…”