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Artificial pancreas may reduce diabetes distress, improve disease management
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Adolescents and adults with type 1 diabetes who used a hybrid closed-loop insulin system reported fewer symptoms of diabetes distress and improved disease management, suggesting the system could improve quality of life for users, according to findings published in Diabetes Technology & Therapeutics.
“Given that [hybrid closed-loop] systems require use of both [continuous glucose monitoring] and the insulin pump, psychosocial and human factors affecting insulin pump and CGM use will apply to these systems, and additional factors … may be important for both initial adjustment and sustained utilization,” Rebecca N. Adams, PhD, of the department of pediatrics at Stanford University School of Medicine, and colleagues wrote in the study background. “Psychological distress is also likely to impact system use and performance, given the well-established relationship between diabetes distress and depression and poorer disease management and glycemic control.”
In the multisite clinical trial, researchers evaluated 14 adults and 15 adolescents with type 1 diabetes in a semisupervised, outpatient environment. Eligible participants were aged 14 to 40 years, had at least a 12-month history of diabetes and required more than 0.4 U/kg daily insulin.
Participants completed online surveys evaluating psychosocial and human factors at baseline and at the conclusion of the study, including four-item management distress subscale of the Diabetes Distress Scale, the 18-item Worry Subscale from the Hypoglycemia Fear Survey and technology attitudes, evaluated through the 30-item Diabetes Technology Questionnaire.
Each study site (Stanford University, University of Colorado and Yale University) had three cohorts, with each cohort using one of two hybrid closed-loop systems. System A consisted of an Android-based platform and a third-generation Enlite sensor (Medtronic), which operated through communication between the pump, translator and Android phone. Remote monitoring was provided through the Android phone. System B utilized a fourth-generation Guardian Sensor 3 sensor and a prototype of the MiniMed 670G insulin pump (Medtronic). The pump and algorithm of system B were integrated, but this system was not capable of remote monitoring, according to the researchers. Participants were instructed to eat and exercise as usual.
The researchers used t tests and regression analyses to assess changes in psychosocial factors after use of the artificial pancreas system. Glycemic outcomes were also predicted.
The researchers found that participants reported less management distress at the conclusion of the closed-loop trial (P = .01). Conversely, fear of hypoglycemia did not change during the study interval. Patients exhibited improvements in attitudes toward their diabetes technology regimens after trying the closed-loop system (P = .001). The improvements in management distress and diabetes technology attitudes were statistically significant, but minor, according to researchers.
In an analysis controlling for time-in-range before the trial, none of the psychosocial or human factors were predictive of closed-loop sensor glucose data, the researchers wrote.
“Distress related to diabetes management was reduced after using the system and is also a potential predictor of system outcomes,” they wrote. “Findings show that the [hybrid closed-loop] system is promising for reducing patient burden and has clinical and research implications for interventions to improve quality of life and glycemic outcomes.” – by Jennifer Byrne
Disclosures: Adams reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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