An interview study from the ACBRD details experiences with a brief overnight trial of a hybrid closed-loop system
In recent years, significant progress has been made in terms of the technologies for insulin delivery and glucose monitoring, including hybrid closed-loop (HCL) technology (sometimes referred to as the ‘artificial pancreas’). HCL technology uses a computer algorithm that enables insulin pumps and continuous glucose monitors to “talk” to each other. Insulin dosing can then be automated according to an individual’s glucose levels, resulting in a “closed loop” system that potentially requires less input by the person with diabetes. Currently, this technology is not commercially available in Australia, as it is still in a research and development phase. Little is known about the psychological and behavioural aspects of using HCL technology. This is because research has mostly focused on safety and efficacy in terms of medical outcomes in carefully monitored situations (e.g. overnight, in hospital), rather than on the psychological experience of the user in their everyday life. Therefore, we conducted interviews with participants who were trialling HCL technology overnight in their own homes to get a better understanding of their experiences.
This interview study, led by Dr Christel Hendrieckx, was part of a randomised controlled crossover trial. Participants were 16 adults with diabetes, all of whom were using an insulin pump and most had experience with continuous glucose monitoring. Participants used the HCL system at home, overnight only, for four consecutive nights. They activated the HCL system each evening, two hours after dinner, and stopped each morning before breakfast. For safety reasons, participants were monitored remotely by clinicians and a technology team, and had access to a 24-hour helpline. On the fifth morning, researchers interviewed participants to gain an understanding of their experiences, understanding, and expectations of the system.
Participants generally found the HCL system easy to use, indicating that it offered benefits over insulin pumps, and they had a good understanding of how it adjusted their insulin delivery according to their glucose levels. However, most participants reported technical issues, such as “malfunctions with the closed-loop system”, sensor inaccuracies and issues with alarms. Despite this, participants were generally confident that the technology was working, and trusted it. Participants felt safer knowing that professionals were monitoring them remotely: “I felt safe, I knew they were all up there watching”. In terms of diabetes outcomes, many participants were impressed by the “flat lining” of their glucose levels, and how long they “sat in range” overnight. This resulted in fewer hypoglycaemic episodes (hypos; low glucose levels), and improved glucose levels during the day. These experiences meant that participants predicted that their lives would become much easier and more flexible if they could use HCL technology in the future. However, participants indicated that the device needed to be smaller for future routine use.
Overall, participants’ experiences with the HCL system were mainly positive, but they suggested several areas for improvement. Participants felt safer knowing that they were being monitored, which suggests that future HCL technology users might benefit from this kind of support (at least initially). We recognise that technologies are continually evolving and improving. Nonetheless, this study and others like it are vital for ensuring that users’ experiences inform our understanding of how to improve HCL technology, and the support needed for its future implementation, to benefit people with type 1 diabetes.
To read more about this HCL trial, check out our previous blog.
Our team is now collaborating on a much larger multi-centre trial of HCL technology, involving 120 adults with type 1 diabetes across Australia, which will conclude late 2019. You can read the study protocol here.
Hendrieckx C, Poole LA, Sharifi A, Jayawardene D, Loh MM, Horsburgh JC, Bach LA, Colman PG, Kumareswaran K, Jenkins AJ, MacIsaac RJ, Ward GM, Grosman B, Roy A , O’Neal DN, Speight J. ‘It is definitely a game changer’: a qualitative study of experiences with in-home overnight closed-loop technology among adults with type 1 diabetes. Diabetes Technology & Therapudics, 2017; 9(7): 410-416
Acknowledgements: This research was funded by JDRF International.
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