title: Psychosocial aspects of closed- and open-loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting.
abstract: OBJECTIVE
  To explore the psychosocial experiences of closed-loop technology and to compare ratings of closed- and open-loop technology for adults with Type 1 diabetes taking part in a randomized crossover study.
  
  
  METHODS
  Adults (aged > 18 years) on insulin pump therapy were recruited to receive a first phase of either real-time continuous glucose monitoring with overnight closed-loop or real-time continuous glucose monitoring alone (open-loop) followed by a second phase of the alternative treatment in random order, at home for 4 weeks, unsupervised. Participants were invited to share their views in semi-structured interviews. The impact of the closed-loop technology, positive and negative aspects of living with the device overnight, along with the hopes and anxieties of the participants, were explored.
  
  
  RESULTS
  The participants in the trial were 24 adults with a mean (sd) age of 43 (12) years, of whom 54% were men. The mean (range) interview duration was 26 (12-46) min. Content and thematic analysis showed the following key positive themes: improved blood glucose control (n = 16); reassurance/reduced worry (n = 16); improved overnight control leading to improved daily functioning and diabetes control (n = 16); and improved sleep (n = 8). The key negative themes were: technical difficulties (n = 24); intrusiveness of alarms (n = 13); and size of equipment (n = 7). Of the 24 participant, 20 would recommend the closed-loop technology.
  
  
  CONCLUSIONS
  Closed-loop therapy has positive effects when it works in freeing participants from the demands of self-management. The downside was technical difficulties, particularly concerning the pump and 'connectivity', which it is hoped will improve. Future research should continue to explore the acceptability of the closed-loop system as a realistic therapy option, taking account of user concerns as new systems are designed. Failure to do this may reduce the eventual utility of new systems.
authors.affiliation: HDH, Faculty of Medicine, University of Southampton, Southampton, UK.
authors.forename: K D
authors.initials: KD
authors.lastname: Barnard
authors.forename: T
authors.initials: T
authors.lastname: Wysocki
authors.forename: H
authors.initials: H
authors.lastname: Thabit
authors.forename: M L
authors.initials: ML
authors.lastname: Evans
authors.forename: S
authors.initials: S
authors.lastname: Amiel
authors.forename: S
authors.initials: S
authors.lastname: Heller
authors.forename: A
authors.initials: A
authors.lastname: Young
authors.forename: R
authors.initials: R
authors.lastname: Hovorka
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D001007:Anxiety / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use*; D007332:Insulin Infusion Systems / Q000145:classification* / Q000523:psychology*; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011584:Psychology; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin