scholarly journals Adolescents’ Experiences of Using a Smartphone Application Hosting a Closed-loop Algorithm to Manage Type 1 Diabetes in Everyday Life: Qualitative Study

2021 ◽  
pp. 193229682199420
Author(s):  
David Rankin ◽  
Barbara Kimbell ◽  
Janet M. Allen ◽  
Rachel E. J. Besser ◽  
Charlotte K. Boughton ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Management Practices ◽  
Closed Loop ◽  
Age Groups ◽  
Insulin Delivery ◽  
Smartphone Application ◽  
Self Management ◽  
Smartphone App ◽  
Medical App

Background: Closed-loop technology may help address health disparities experienced by adolescents, who are more likely to have suboptimal glycemic control than other age groups and, because of their age, find diabetes self-management particularly challenging. The CamAPS FX closed-loop has sought to address accessibility and usability issues reported by users of previous prototype systems. It comprises small components and a smartphone app used to: announce meal-time boluses, adjust (“boost” or “ease-off”) closed-loop insulin delivery, customize alarms, and review/share data. We explored how using the CamAPS FX platform influences adolescents’ self-management practices and everyday lives. Methods: Eighteen adolescents were interviewed after having ≥6 months experience using the closed-loop platform. Data were analyzed thematically. Results: Participants reported feeling less burdened and shackled by diabetes because closed-loop components were easier to carry/wear, finger-pricks were not required, the smartphone app provided a discreet and less stigmatizing way of managing diabetes in public, and they were able to customize alarms. Participants also reported checking and reviewing data more regularly, because they did so when using the smartphone for other reasons. Some reported challenges in school settings where use of personal phones was restricted. Participants highlighted how self-management practices were improved because they could easily review glucose data and adjust closed-loop insulin delivery using the “boost” and “ease-off” functions. Some described how using the system resulted in them forgetting about diabetes and neglecting certain tasks. Conclusions: A closed-loop system with small components and control algorithm on a smartphone app can enhance usability and acceptability for adolescents and may help address the health-related disparities experienced by this age group. However, challenges can arise from using a medical app on a device which doubles as a smartphone. Trial registration: Closed Loop From Onset in Type 1 Diabetes (CLOuD); NCT02871089; https://clinicaltrials.gov/ct2/show/NCT02871089

scholarly journals Hybrid Closed-Loop Insulin Delivery Systems for People With Type 1 Diabetes

2021 ◽  
Vol 1 (3) ◽  
Author(s):  
CADTH Health Technology Assessment Service
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Closed Loop ◽  
Insulin Pump ◽  
Insulin Delivery ◽  
Blood Glucose Monitoring ◽  
Self Management ◽  
Publicly Funded ◽  
Delivery Methods

Blood glucose monitoring and insulin delivery are essential parts of the management of type 1 diabetes. Hybrid closed-loop insulin delivery (HCL) systems are a treatment option for people with type 1 diabetes and consist of an insulin pump, a continuous glucose monitor (CGM), and a computer program (algorithm) that allows the devices to communicate with each other and calculates insulin needs. CADTH conducted a Health Technology Assessment (HTA) of the use of HCL systems compared to other insulin delivery methods in people with type 1 diabetes to inform decisions regarding whether HCL systems have a place in the management of type 1 diabetes. HCL therapy generally improved the amount of time a person spent in target blood glucose ranges. Additionally, people who used HCL systems had improved average blood glucose levels (glycated hemoglobin [A1C]) over the preceding 2 or 3 months. However, the effectiveness or safety of HCL systems based on age, sex, race, glucose management, or other clinical features (e.g., those who are pregnant or planning pregnancy, or who have hypoglycemia unawareness or a history of severe hypoglycemia) is unknown. HCL systems were generally as safe as other insulin delivery methods. Additional studies with longer follow-up periods and more participants are needed to confirm the clinical effectiveness and safety of HCL systems. From a pan-Canadian, publicly funded health care system perspective, the cost of covering HCL systems for individuals with type 1 diabetes who are eligible for insulin pumps in their jurisdictions was estimated to be an additional $822,635,045 over 3 years compared with diabetes supplies that are currently covered. If HCL systems are covered for all individuals with type 1 diabetes, regardless of their current insulin-pump eligibility, the budget impact will be higher. HCL systems can help provide distance from demanding self-management and monitoring tasks for people living with type 1 diabetes; however, in order to do this, people using these systems must navigate complex relationships built on trust and collaboration. Given that type 1 diabetes self-management to date has required considerable attention to blood glucose numbers and technical tasks, developing these relationships of trust and collaboration will require a shift in understanding what it means to care for someone who has — or to self-manage — type 1 diabetes. It is not possible to conclude whether HCL systems will improve overall population health over the longer-term because the data for this are not available. It is also unclear which people with type 1 diabetes would benefit most from HCL systems. Eligibility criteria for the existing public insulin-pump program may be useful in making coverage decisions; trial periods may be considered to ensure HCL systems are working well for new users. Education and support are needed for people living with type 1 diabetes when they start to use HCL systems. Clinicians noted the need for interactions between diabetes educators and HCL system pump users. User-friendly devices and understandable reports are key to effective use. Eligibility for access through any publicly funded program for HCL systems should be based on evidence. The criteria for coverage should be consistent with broader public health goals and should not contribute to existing inequities in diabetes management.

1065-P: The Effect of a Closed-Loop Insulin Delivery System on Glycemic Control in Type 1 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1065-P ◽  
Author(s):  
ANASTASIOS KOUTSOVASILIS ◽  
ALEXIOS SOTIROPOULOS ◽  
ANASTASIA ANTONIOU ◽  
VASILIOS KORDINAS ◽  
DESPINA PAPADAKI ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Delivery System ◽  
Closed Loop ◽  
Insulin Delivery ◽  
Insulin Delivery System

725-P: Reducing Hypoglycemic Risk during Postprandial Exercise with Closed-Loop Insulin Delivery in Adults with Type 1 Diabetes: Announced and Unannounced Exercise

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 725-P
Author(s):  
SEMAH TAGOUGUI ◽  
NADINE TALEB ◽  
CORINNE SUPPERE ◽  
INÈS BOUKABOUS ◽  
VIRGINIE MESSIER ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Closed Loop ◽  
Insulin Delivery

Open-source automated insulin delivery systems for the management of type 1 diabetes during pregnancy

2021 ◽  
Vol 14 (9) ◽  
pp. e243522
Author(s):  
Khulood Bukhari ◽  
Rana Malek
Keyword(s):  
Type 1 Diabetes ◽  
Open Source ◽  
Closed Loop ◽  
Glycated Hemoglobin ◽  
Insulin Delivery ◽  
Third Trimester ◽  
Time In Range ◽  
Insulin Delivery System ◽  
Iphone Application

A 40-year-old woman used an open-source automated insulin delivery system to manage her type 1 diabetes (T1D) prior to conception. The code for building the iPhone application called ‘Loop’ that carried the software for the hybrid closed-loop controller was available online. Her glycated hemoglobin before conception was 6.4%. Between 6 and 12 weeks gestation, she spent 66% time-in-range (TIR), 28% time-above-range (TAR) and 6% time-below-range (TBR). Between 18 and 24 weeks gestation, she spent 68% TIR, 27% TAR and 5% TBR. During her third trimester, she spent 72% TIR, 21% TAR and 7% TBR. She delivered a healthy infant with no neonatal complications. Clinicians should be aware of this technology as it gains traction in the T1D community and seeks Food and Drug Administration approval.

scholarly journals Day-and-Night Hybrid Closed-Loop Insulin Delivery in Adolescents With Type 1 Diabetes: A Free-Living, Randomized Clinical Trial

Diabetes Care ◽  
2016 ◽  
Vol 39 (7) ◽  
pp. 1168-1174 ◽  
Author(s):  
Martin Tauschmann ◽  
Janet M. Allen ◽  
Malgorzata E. Wilinska ◽  
Hood Thabit ◽  
Zoë Stewart ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Type 1 Diabetes ◽  
Randomized Clinical Trial ◽  
Closed Loop ◽  
Insulin Delivery ◽  
Free Living
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