Participants' Experiences of, and Views About, Daytime Use of a Day-and-Night Hybrid Closed-Loop System in Real Life Settings: Longitudinal Qualitative Study

Abstract

Objective: To explore individuals' experiences of daytime use of a day-and-night hybrid closed-loop system, their information and support needs, and their views about how future systems could be improved.

Research design and methods: Twenty-four adults, adolescents, and parents were interviewed before using a hybrid day-and-night closed-loop system and 3 months later, data were analyzed thematically.

Results: Participants praised the closed loop's ability to respond to high and low blood glucose in ways which extended beyond their own capabilities and to act as a safety net and mop up errors, such as when a mealtime bolus was forgotten or unplanned activity was undertaken. Participants also described feeling less burdened by diabetes as a consequence and more able to lead flexible, spontaneous lives. Contrary to their initial expectations, and after trust in the system had been established, most individuals wanted opportunities to collaborate with the closed loop to optimize its effectiveness. Such individuals expressed a need to communicate information, such as when routines changed or to indicate different intensities of physical activity. While individuals valued frequent contact with staff in the initial month of use, most felt that their long-term support needs would be no greater than when using an insulin pump.

Conclusions: While participants reported substantial benefits to using the closed loop during the day, they also identified ways in which the technology could be refined and education and training tailored to optimize effective use. Our findings suggest that mainstreaming this technology will not necessarily lead to increased demands on clinical staff.

Keywords: Artificial pancreas; Closed-loop system; Medical device; Qualitative research; Type 1 diabetes; User experience.

Conflict of interest statement

R.H. reports having received speaker honoraria from Eli Lilly and Novo Nordisk, serving on advisory panel for Eli Lilly and Novo Nordisk, receiving license fees from BBraun and Medtronic. R.H. and M.E.W. report patent patents and patent applications. M.E.W. reports receiving license fees from Becton Dickinson and serving as a consultant for Becton Dickinson. M.T. reports having received speaker honoraria from Novo Nordisk and Medtronic. L.L. reports having received speaker honoraria from Medtronic, Animas, Roche, Sanofi, Insulet, and Novo Nordisk, serving on advisory panel for Abbott Diabetes Care, Roche, Sanofi, Medtronic, Animas, and Novo Nordisk, grants to attend educational meetings from Sanofi, Novo Nordisk, and Takeda. F.M.C. reports receiving speaking fees from Medtronic, Eli Lilly, and Abbott and serving on Advisory Boards for Medtronic, Novo Nordisk, Insulet, and Eli Lilly. H.T. reports receiving research support from Dexcom. J.L., M.B., J.M.A., D.E., and D.R.—no competing financial interests exist.