Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
Wellcome Trust-Medical Research Council Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
Diabet Med. 2017 Oct;34(10):1461-1469. doi: 10.1111/dme.13406. Epub 2017 Jul 21.
To explore the experiences of pregnant women with Type 1 diabetes, and the relationships between perceptions of glucose control, attitudes to technology and glycaemic responses with regard to closed-loop insulin delivery.
We recruited 16 pregnant women with Type 1 diabetes [mean ± sd age 34.1 ± 4.6 years, duration of diabetes 23.6 ± 7.2 years, baseline HbA 51±5 mmol/mol (6.8 ± 0.6%)] to a randomized crossover trial of sensor-augmented pump therapy vs automated closed-loop therapy. Questionnaires (Diabetes Technology Questionnaire, Hypoglycaemia Fear Survey) were completed before and after each intervention, with qualitative interviews at baseline and follow-up.
Women described the benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and empowerment were counterbalanced by concerns about device visibility, obsessive data checking and diminished attentiveness to hyper- and hypoglycaemia symptoms. Responding to questionnaires, eight participants felt less worry about overnight hypoglycaemia and that diabetes 'did not run their lives'; however, five reported that closed-loop increased time thinking about diabetes, and three felt it made sleep and preventing hyperglycaemia more problematic. Women slightly overestimated their glycaemic response to closed-loop therapy. Most became more positive in their technology attitudes throughout pregnancy. Women with more positive technology attitudes had higher degrees of overestimation, and poorer levels of glycaemic control.
Women displayed complex psychosocial responses to closed-loop therapy in pregnancy. Perceptions of glycaemic response may diverge from biomedical data.
探讨 1 型糖尿病孕妇的体验，以及闭环胰岛素输送与血糖控制感知、对技术的态度与血糖反应之间的关系。
我们招募了 16 名 1 型糖尿病孕妇[平均年龄±标准差 34.1±4.6 岁，糖尿病病程 23.6±7.2 年，基线 HbA1c51±5mmol/mol（6.8±0.6%）]参加了传感器增强型泵治疗与自动化闭环治疗的随机交叉试验。在每次干预前后完成问卷调查（糖尿病技术问卷、低血糖恐惧调查），并在基线和随访时进行定性访谈。
女性在怀孕期间描述了闭环系统的益处和负担。改善血糖控制的感觉、兴奋和赋权感与对设备可见性、过度数据检查和对高血糖和低血糖症状关注度降低的担忧相平衡。在回答问卷时，8 名参与者对夜间低血糖的担忧感减轻，并且认为糖尿病“没有主宰他们的生活”；然而，5 名参与者报告闭环增加了他们对糖尿病的思考时间，3 名参与者感到它使睡眠和预防高血糖更加困难。女性对闭环治疗的血糖反应略有高估。大多数女性在整个孕期对技术的态度更加积极。对技术态度越积极的女性，高估程度越高，血糖控制水平越差。
女性在怀孕期间对闭环治疗表现出复杂的心理社会反应。对血糖反应的感知可能与生物医学数据不一致。
