title: Closing the loop overnight at home setting: psychosocial impact for adolescents with type 1 diabetes and their parents.
abstract: OBJECTIVE
  To explore the experiences of adolescents with type 1 diabetes mellitus (T1DM) and their parents taking part in an overnight closed loop study at home, using qualitative and quantitative research methods.
  
  
  METHODS
  Adolescents aged 12-18 years on insulin pump therapy were recruited to a pilot closed loop study in the home setting. Following training on the use of a study insulin pump and continuous glucose monitoring (CGM), participants were randomized to receive either real-time CGM combined with overnight closed loop or real-time CGM alone followed by the alternative treatment for an additional 21 days with a 2-3-week washout period in between study arms. Semistructured interviews were performed to explore participants' perceptions of the impact of the closed loop technology. At study entry and again at the end of each 21-day crossover arm of the trial, participants completed the Diabetes Technology Questionnaire (DTQ) and Hypoglycemia Fear Survey (HFS; also completed by parents).
  
  
  RESULTS
  15 adolescents and 13 parents were interviewed. Key positive themes included reassurance/peace of mind, confidence, 'time off' from diabetes demands, safety, and improved diabetes control. Key negative themes included difficulties with calibration, alarms, and size of the devices. DTQ results reflected these findings. HFS scores were mixed.
  
  
  CONCLUSIONS
  Closed loop insulin delivery represents cutting-edge technology in the treatment of T1DM. Results indicate that the psychological and physical benefits of the closed loop system outweighed the practical challenges reported. Further research from longitudinal studies is required to determine the long-term psychosocial benefit of the closed loop technology.
authors.affiliation: Human Development and Health Academic Unit, Faculty of Medicine , University of Southampton , Southampton , UK.
authors.forename: Katharine D
authors.initials: KD
authors.lastname: Barnard
authors.affiliation: Center for Healthcare Delivery Science, Nemours Children's Health System , Jacksonville, Florida , USA.
authors.forename: Tim
authors.initials: T
authors.lastname: Wysocki
authors.affiliation: Department of Paediatrics , University of Cambridge , Cambridge , UK ; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Allen
authors.affiliation: Department of Paediatrics , University of Cambridge , Cambridge , UK ; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Daniela
authors.initials: D
authors.lastname: Elleri
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Hood
authors.initials: H
authors.lastname: Thabit
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Lalantha
authors.initials: L
authors.lastname: Leelarathna
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Arti
authors.initials: A
authors.lastname: Gulati
authors.affiliation: Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Marianna
authors.initials: M
authors.lastname: Nodale
authors.affiliation: Department of Paediatrics , University of Cambridge , Cambridge , UK.
authors.forename: David B
authors.initials: DB
authors.lastname: Dunger
authors.affiliation: MRC Lifecourse Epidemiology Unit , University of Southampton , Southampton , UK.
authors.forename: Tannaze
authors.initials: T
authors.lastname: Tinati
authors.affiliation: Department of Paediatrics , University of Cambridge , Cambridge , UK ; Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge , Cambridge , UK.
authors.forename: Roman
authors.initials: R
authors.lastname: Hovorka
keywords: Adolescent Diabetes; Artificial Pancreas; Psychosocial Factors; Type 1