title: Closing the Loop in Adults, Children and Adolescents With Suboptimally Controlled Type 1 Diabetes Under Free Living Conditions: A Psychosocial Substudy.
abstract: OBJECTIVE
  The objective was to explore psychosocial experiences of closed loop technology for adults, children, and adolescents with type 1 diabetes and their parents taking part in two multicenter, free-living, randomized crossover home studies.
  
  
  METHODS
  Participants using insulin pump therapy were randomized to either 12 weeks of automated closed-loop glucose control, then 12 weeks of sensor augmented insulin pump therapy (open loop), or vice versa. Closed loop was used for 24 hours by adults and overnight only by children and adolescents. Participants completed the Diabetes Technology Questionnaire (DTQ) periodically and shared their views in semistructured interviews. This analysis characterizes the impact of the technology, positive and negative aspects of living with the device, alongside participants' expectations, hopes, and anxieties.
  
  
  RESULTS
  Participants were 32 adults, age 38.6 ± 9.6 years, 55% male, and 26 children, mean age 12 years (range 6-18 years), 54% male. DTQ results indicated moderately favorable impact of, and satisfaction with, both open and closed loop interventions, but little evidence of a comparative advantage of either. Key positive themes included perceived improved blood glucose control, improved general well-being, particularly on waking, improved sleep, reduced burden of diabetes, and visibility of data. Key negative themes included having to carry around the equipment and dislike of the pump and second cannula (ie, sensor) inserted.
  
  
  CONCLUSIONS
  Overall, participants reported a positive experience of the closed loop technology. Results are consistent with previous research with size of equipment continuing to be a problem. Progress is being made in the usability of the closed-loop system.
authors.affiliation: 1 Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK.
authors.forename: Katharine D
authors.initials: KD
authors.lastname: Barnard
authors.affiliation: 2 Nemours Children's Health System, Jacksonville, FL, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wysocki
authors.affiliation: 3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Ully
authors.affiliation: 3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Julia K
authors.initials: JK
authors.lastname: Mader
authors.affiliation: 3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Pieber
authors.affiliation: 4 Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.|5 Wolfson Diabetes Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Hood
authors.initials: H
authors.lastname: Thabit
authors.affiliation: 4 Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.|6 Department of Paediatrics, University of Cambridge, Cambridge, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Tauschmann
authors.affiliation: 4 Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.|5 Wolfson Diabetes Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Lalantha
authors.initials: L
authors.lastname: Leelarathna
authors.affiliation: 5 Wolfson Diabetes Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Hartnell
authors.affiliation: 6 Department of Paediatrics, University of Cambridge, Cambridge, UK.
authors.forename: Carlo L
authors.initials: CL
authors.lastname: Acerini
authors.affiliation: 4 Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
authors.forename: Malgorzata E
authors.initials: ME
authors.lastname: Wilinska
authors.affiliation: 7 Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Dellweg
authors.affiliation: 7 Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Benesch
authors.affiliation: 7 Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Arnolds
authors.affiliation: 3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Manuel
authors.initials: M
authors.lastname: Holzer
authors.affiliation: 3 Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Harald
authors.initials: H
authors.lastname: Kojzar
authors.affiliation: 8 Leeds Children's Hospital, Leeds, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.affiliation: 8 Leeds Children's Hospital, Leeds, UK.
authors.forename: James
authors.initials: J
authors.lastname: Yong
authors.affiliation: 9 Institute of Child Health, University College London Hospital, London, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Pichierri
authors.affiliation: 9 Institute of Child Health, University College London Hospital, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Hindmarsh
authors.affiliation: 7 Profil Institut für Stoffwechselforschung GmbH, Neuss, Germany.
authors.forename: Lutz
authors.initials: L
authors.lastname: Heinemann
authors.affiliation: 4 Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.|5 Wolfson Diabetes Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Evans
authors.affiliation: 4 Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
authors.forename: Roman
authors.initials: R
authors.lastname: Hovorka
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D015190:Blood Glucose Self-Monitoring; D002648:Child; D017281:Cost of Illness; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005060:Europe; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: artificial pancreas; closed loop; psychosocial; type 1 diabetes