Who Should Access Closed-Loop Technology? A Qualitative Study of Clinician Attitudes in England

Abstract

Background: Clinicians mediate access to closed-loop technology for people with diabetes. Consequently, their attitudes regarding appropriate levels of closed-loop usage will play a key role in future adoption processes. This study aimed to explore clinician attitudes toward future mainstream closed-loop usage in England. Materials and Methods: We conducted 36 semistructured interviews with clinicians from a range of professional backgrounds working in outpatient clinics in England. Interview topics included clinicians' views on future pathways for closed-loop use and attitudes toward the predictability of users' technology experiences, a key factor in eligibility decision making. We analyzed transcripts using thematic and framework approaches. Results: Clinicians exhibited a range of opinions regarding future eligibility for closed-loop technology. We identified three key strands of clinician opinion, envisaging (1) tighter access for closed loop (n = 10), citing funding challenges and issues arising from user overconfidence or negative technology attitudes; (2) similar access to closed loop as for current diabetes technologies (n = 15), on the grounds that future funding and access pathways will be similar to current arrangements; and (3) wider access for closed-loop technologies (n = 9), given the potential for significant and widespread benefits arising from closed-loop usage, including downstream cost savings alongside improved glycemic control. Conclusions: Clinicians expressed a range of opinions encompassing continuity with current diabetes technologies, while others envisaged either tighter or more liberal access for closed-loop systems. To optimize technology adoption and equitable uptake, future implementation pathways should consider clinician attitudes toward technology use and access.

A pilot randomised-controlled parallel arm trial evaluating treatment satisfaction with the Omnipod DASH® Insulin Management System compared with usual care in adults with type 1 diabetes in Australia: Rationale, Study Design and Methodologies.

“…Secondary Healthcare Professional Perceptions: Two healthcare professionals (one doctor and one nurse) from each of the four study sites will be interviewed about their perceptions of the Omnipod DASH® System and their recommendations for further re nement at study completion. The topic guide for the healthcare professionals will be informed by analysis of the participant interviews and research that has explored clinician attitudes towards technology use (24,25).…”

Automated Insulin Delivery Systems: Today, Tomorrow and User Requirements

“…Data assessing clinician views of AID systems have been published 27,28 and similar work has been undertaken to explore the views of existing and future users. 29-31 Co-design, involvement of people with lived experience of T1D and robust qualitative assessment is critical to improving the real-world use of AID systems, especially for those who may have greater need.…”

Rollout of Closed-Loop Technology to Pregnant Women with Type 1 Diabetes: Healthcare Professionals' Views About Potential Challenges and Solutions

“…9 Healthcare professionals play pivotal roles in mediating people's expectations, experiences and use of diabetes technologies. [10][11][12][13][14][15] Hence, to support pregnant women using HCL, it is important that their perspectives are considered. To date, interview studies have focused on healthcare professionals' experiences of supporting adolescents using HCL, 14,16 or have consulted those with limited knowledge and first-hand experience of using HCL in T1D pregnancy.…”

“…To date, interview studies have focused on healthcare professionals' experiences of supporting adolescents using HCL, 14,16 or have consulted those with limited knowledge and first-hand experience of using HCL in T1D pregnancy. 12,17 To address this gap in the literature and provide bespoke recommendations for supporting HCL use in pregnancy, we report findings from interviews with healthcare professionals who participated in a UK-based, multi-centre, randomized controlled trial -Automated insulin Delivery Among Pregnant women with Type 1 diabetes (AiDAPT). The trial, which began in September 2019 and closed out in November 2022, explored the biomedical and psychosocial effects of using HCL (CamAPS FX) compared with CGM in pregnant women (aged 18-45 years) receiving routine clinical care.…”