Mizokami-Stout Kara, Thompson Holly M, Hurren Kathryn, Leone Virginia, Piatt Gretchen A, Lee Joyce M, Pop-Busui Rodica, DeJonckheere Melissa
Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States.
Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI, United States.
JMIR Diabetes. 2023 Mar 29;8:e45241. doi: 10.2196/45241.
Hybrid closed loop (HCL) insulin pumps adjust insulin delivery based on input from a continuous glucose monitor. Several systems are FDA approved and associated with improved time in range, reduction in hemoglobin A, and decreased incidence of hypoglycemia. Major diabetes guidelines differ in their strength of recommendations regarding the use of HCL systems. Overall, limited information about the factors that influence HCL pump clinical decision-making is available, especially among endocrinology clinicians.
The study objective is to describe the knowledge and attitudes, network support, and self-efficacy regarding HCL insulin delivery systems among endocrinology clinicians in one Veterans Affairs (VA) Healthcare System in the Midwest.
Following a descriptive approach, this qualitative study used semistructured interviews and inductive thematic analysis. All endocrinologists, endocrinology fellows, and nurses in the endocrinology and metabolism department at one VA Healthcare System in the Midwest were invited to participate in one-on-one phone interviews. Thematic analysis explored clinician perspectives on HCL insulin pump systems.
Participants (n=11) had experience within VA and university health care system endocrinology clinics. From their experiences, 4 themes were identified involving the evaluation and assessment of insulin pump candidates, prescribing challenges, clinical benefits of HCL pumps, and overall clinician confidence.
Findings suggest that clinicians believe HCL systems have significant glycemic benefits but are not appropriate for all patients, especially those with cognitive impairment. HCL pump initiation is a multi-step process requiring an interdisciplinary team of health care clinicians to ensure patient and pump success. Furthermore, HCL systems improve clinician confidence in overall diabetes management.
混合闭环（HCL）胰岛素泵根据连续血糖监测仪的输入来调整胰岛素输注量。有几种系统已获得美国食品药品监督管理局（FDA）批准，与血糖达标时间改善、糖化血红蛋白降低以及低血糖发生率下降相关。主要的糖尿病指南对于使用HCL系统的推荐力度有所不同。总体而言，关于影响HCL泵临床决策的因素的信息有限，尤其是在内分泌科临床医生中。
本研究的目的是描述中西部一个退伍军人事务（VA）医疗系统中内分泌科临床医生对HCL胰岛素输注系统的知识和态度、网络支持以及自我效能感。
采用描述性方法，本定性研究使用半结构化访谈和归纳性主题分析。邀请了中西部一个VA医疗系统内分泌与代谢科的所有内分泌科医生、内分泌科住院医师和护士参加一对一电话访谈。主题分析探讨了临床医生对HCL胰岛素泵系统的看法。
参与者（n = 11）在VA和大学医疗系统内分泌诊所都有工作经验。从他们的经验中，确定了4个主题，涉及胰岛素泵候选者的评估与评价、处方开具挑战、HCL泵的临床益处以及临床医生的总体信心。
研究结果表明，临床医生认为HCL系统对血糖有显著益处，但并非适用于所有患者，尤其是那些有认知障碍的患者。启动HCL泵是一个多步骤过程，需要医疗保健临床医生组成的跨学科团队来确保患者和泵的成功。此外，HCL系统提高了临床医生对整体糖尿病管理的信心。
