1 School of Psychology, Deakin University , Geelong, Victoria, Australia .
2 The Australian Center for Behavioral Research in Diabetes , Diabetes Victoria, Melbourne, Victoria, Australia .
Diabetes Technol Ther. 2017 Jul;19(7):410-416. doi: 10.1089/dia.2017.0007. Epub 2017 May 24.
This qualitative study explored trial participants' experiences of four nights of in-home closed loop.
Sixteen adults with type 1 diabetes, who completed a randomized crossover trial, were interviewed after four consecutive nights of closed-loop. Interviews were audio recorded, transcribed, and analyzed with a coding framework developed to identify the main themes.
Participants had a mean age of 42 ± 10 years, nine were women; mean diabetes duration was 27 ± 7 years, and all were using insulin pumps. Overall, first impressions were positive. Participants found closed-loop easy to use and understand. Most experienced more stable overnight glucose levels, although for some these were similar to usual care or higher than they expected. Compared with their usual treatment, they noticed the proactive nature of the closed-loop, being able to predict trends and deliver micro amounts of insulin. Most reported technical glitches or inconveniences during one or more nights, such as transmission problems, problematic connectivity between devices, ongoing alarms despite addressing low glucose levels, and sensor inaccuracy. Remote monitoring by the trial team and their own hypoglycemic awareness contributed to feelings of trust and safety. Although rare, safety concerns were raised, related to feeling unsure whether the system would respond in time to falling glucose levels.
This study provides relevant insights for implementation of closed-loop in the real world. For people with diabetes who are less familiar with technology, remote monitoring for the first few days may provide reassurance, strengthen their trust/skills, and make closed-loop an acceptable option for more people with type 1 diabetes.
本定性研究探讨了 16 名 1 型糖尿病患者参与四晚家庭闭环的体验。
16 名参与者完成了一项随机交叉试验，在连续四晚闭环后接受了访谈。访谈内容进行了录音、转录，并采用了一种编码框架进行分析，以确定主要主题。
参与者的平均年龄为 42±10 岁，其中 9 名为女性；平均糖尿病病程为 27±7 年，均使用胰岛素泵。总体而言，第一印象是积极的。参与者发现闭环系统易于使用和理解。大多数人发现夜间血糖水平更稳定，尽管对于一些人来说，这些水平与常规护理相似，或者高于他们的预期。与他们的常规治疗相比，他们注意到闭环系统的主动性，能够预测趋势并微量输注胰岛素。大多数人在一个或多个晚上报告了技术故障或不便，例如传输问题、设备之间的连接问题、尽管已解决低血糖问题但仍持续报警以及传感器不准确。试验团队的远程监测和他们自己的低血糖意识有助于增强信任和安全感。尽管很少见，但还是提出了一些安全问题，与对系统是否能及时响应血糖下降感到不确定有关。
本研究为闭环在现实世界中的实施提供了相关的见解。对于不太熟悉技术的糖尿病患者，前几天的远程监测可能会提供安心、增强他们的信任/技能，并使闭环成为更多 1 型糖尿病患者的可接受选择。
