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

David Rankin, Barbara Kimbell, Janet M Allen, Rachel E J Besser, Charlotte K Boughton, Fiona Campbell, Daniela Elleri, Julia Fuchs, Atrayee Ghatak, Tabitha Randell, Ajay Thankamony, Nicola Trevelyan, Malgorzata E Wilinska, Roman Hovorka, Julia Lawton, David Rankin, Barbara Kimbell, Janet M Allen, Rachel E J Besser, Charlotte K Boughton, Fiona Campbell, Daniela Elleri, Julia Fuchs, Atrayee Ghatak, Tabitha Randell, Ajay Thankamony, Nicola Trevelyan, Malgorzata E Wilinska, Roman Hovorka, Julia Lawton

Abstract

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://ichgcp.net/clinical-trials-registry/NCT02871089.

Keywords: closed-loop; continuous glucose monitor; disparities; patient experiences; qualitative methods; type 1 diabetes.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RH 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. RH reports patent patents, patent applications, shareholding, and directorship at CamDiab. REJB reports having received speaking honoraria from Eli Lilly. TR reports having received consultancy fees and honoraria for lectures from NovoNordisk and Abbott Diabetes Care. MEW reports patents and is a consultant at CamDiab. DR, BK, JMA, CKB, FC, DE, JF, AG, NT, AT, and JL declare that there is no conflict of interest.

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Source: PubMed

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