Hybrid closed-loop therapy offers greater independence for young people with diabetes
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Use of a hybrid closed-loop insulin delivery system provided greater independence and flexibility with glycemic management for young people with type 1 diabetes, according to study findings published in Diabetic Medicine.
“The findings of this study provide insight into the user experiences with 6-month use of a first-generation hybrid closed-loop system,” Mary B. Abraham, PhD, consultant endocrinologist at Perth Children’s Hospital in Australia, and colleagues wrote. “The study demonstrated an overall positive experience with improved glycemic control, less anxiety and independence with diabetes management. Technological challenges are expected to improve with future generations of closed-loop systems, which should potentially enhance the maintenance of hybrid closed-loop therapy.”
Researchers conducted a qualitative substudy at the conclusion of a randomized controlled trial in which adolescents and young adults aged 12 to 25 years with type 1 diabetes were randomly assigned to use a MiniMed 670G hybrid closed-loop insulin delivery system (Medtronic) or conventional therapy for 6 months. The trial compared glycemic and psychosocial outcomes between the two groups. In the substudy, 17 participants (47% male; mean age, 17.5 years) in the hybrid closed-loop group completed a semi-structured interview at the end of the trial between November 2017 and May 2020. Ten parents also participated in the same interview with their child. The interviews focused on each participant’s experience with using a hybrid closed-loop system, including their confidence and understanding of the technology and using the device during exercise. Researchers used an interview guide developed by the clinical and research staff that designed the trial.
There were three themes identified in the interview. The first theme looked at how participants developed confidence and trust in the hybrid closed-loop system within 2 to 3 weeks of initiating use. Participants said they had more confidence because they were able to visualize glucose levels with the device. During physical activity, participants said they could exercise more spontaneously without the fear of hypoglycemia, and they had fewer interruptions during exercise for glucose checks. Most participants said they felt that the system gave them more independence over their diabetes management with less reliance on their parent. Parents stated the hybrid closed-loop system gave them the confidence and support to allow their child to take on more of their diabetes management.
The second theme focused on how hybrid closed-loop therapy lowered anxiety in both young people and their parents. The reduction in anxiety was attributed to lower incidences of hypoglycemia, the ability to reduce or stop insulin based on sensor glucose levels and the alarm functions with the system. Both parents and young people said they were less anxious about nocturnal hypoglycemia, and parents said they felt that their child was safer with the hybrid closed-loop system when they were away from home.
The final theme focused on issues with use of the hybrid closed-loop system. Most participants said they had some frustration with the number of alarms and notification with the system, especially at night. Some said they spent more time on diabetes management, at times related to extra blood glucose tests for calibration. Some participants said they were frustrated with the conservative correction of hyperglycemia and felt some of their control had been taken away.
“Although youth commented on the alarms, notifications and the increased frequency of blood glucose monitoring as being annoying and intrusive, all youth felt that the benefits of hybrid closed-loop outweighed the extra work,” the researchers wrote. “However, in real life, youth have abandoned hybrid closed-loop for these reasons, highlighting the need to prepare and support youth with type 1 diabetes during clinical reviews.”
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