Psychosocial aspects of closed-and open-loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting
Psychosocial aspects of closed-and open-loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting
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DOI：
10.1111/dme.12706
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发表时间：
2015-05-01
影响因子：
3.5
通讯作者：
Hovorka, R.
中科院分区：
文献类型：
--
作者：
Barnard, K. D.;Wysocki, T.;Hovorka, R.
目的探讨闭环技术的社会心理体验，并比较参与随机交叉研究的1型糖尿病成人患者对闭环技术和开环技术的评分。招募接受胰岛素泵治疗的30名患者（年龄>18岁），接受第一阶段的实时连续葡萄糖监测和过夜闭环或单独的实时连续葡萄糖监测（开环），然后是随机顺序的第二阶段替代治疗，在家中进行4周，无人监督。与会者应邀在半结构化访谈中分享他们的看法。闭环技术的影响，积极和消极方面的设备过夜，沿着的希望和焦虑的参与者，进行了explored.ResultsThe参与者在试验中的24个成年人的平均（SD）年龄为43（12）岁，其中54%是男性。平均（范围）访谈持续时间为26（12-46）分钟。内容和主题分析显示了以下关键的积极主题：改善血糖控制（n=16）;放心/减少担忧（n=16）;改善夜间控制，从而改善日常功能和糖尿病控制（n=16）;改善睡眠（n=8）。关键的负面主题是：技术困难（n=24）;警报侵入性（n=13）;和设备尺寸（n=7）。在24名参与者中，有20人会推荐闭环technology.ConclusionsClosed-loop治疗具有积极的影响，当它的作品在释放参与者的自我管理的要求。缺点是技术上的困难，特别是关于泵和连接性，希望这将得到改善。未来的研究应继续探索闭环系统作为现实治疗选择的可接受性，并在设计新系统时考虑用户的担忧。如果做不到这一点，可能会降低新系统的最终效用。闭环技术具有特定的心理社会益处，支持1型糖尿病成人的最佳自我管理。技术的进步与更大的可用性有关，但需要进一步的开发工作来改善连通性。未来的研究需要确定闭环作为1型糖尿病患者现实治疗选择的整体影响。
AimsTo 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.MethodsAdults (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.ResultsThe 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.ConclusionsClosed-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.What's new?Closed-loop technology has specific psychosocial benefits supporting optimum self-management in adults with Type 1 diabetes. Advances in technology are associated with greater usability, but further development work is necessary to improve connectivity. Future research is required to determine the holistic impact of closed-loop as a realistic therapy choice for people with Type 1 diabetes.