Lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery in a randomised trial.
automated insulin delivery
closed-loop therapy
frailty
functional independence
lived experience
older adults
type 1 diabetes
Journal
Diabetic medicine : a journal of the British Diabetic Association
ISSN: 1464-5491
Titre abrégé: Diabet Med
Pays: England
ID NLM: 8500858
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
revised:
25
10
2022
received:
29
07
2022
accepted:
01
12
2022
pubmed:
6
12
2022
medline:
15
3
2023
entrez:
5
12
2022
Statut:
ppublish
Résumé
To explore the lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery, an area previously receiving minimal attention. Semi-structured interviews were conducted with adults aged 60 years or older with long-duration type 1 diabetes who participated in a randomised, open-label, two-stage crossover trial comparing first-generation closed-loop therapy (MiniMed 670G) versus sensor-augmented pump therapy. Interview recordings were transcribed, thematically analysed and assessed. Twenty-one older adults participated in interviews after using closed-loop therapy. Twenty were functionally independent, without frailty or major cognitive impairment; one was dependent on caregiver assistance, including for diabetes management. Quality of life benefits were identified, including improved sleep and reduced diabetes-related psychological burden, in the context of experiencing improved glucose levels. Gaps between expectations and reality of closed-loop therapy were also experienced, encountering disappointment amongst some participants. The cost was perceived as a barrier to continued closed-loop access post-trial. Usability issues were identified, such as disruptive overnight alarms and sensor inaccuracy. The lived experience of older adults without frailty or major cognitive impairment using first-generation closed-loop therapy was mainly positive and concordant with glycaemic benefits found in the trial. Older adults' lived experience using automated insulin delivery beyond trial environments requires exploration; moreover, the usability needs of older adults should be considered during future device development.
Substances chimiques
Insulin
0
Hypoglycemic Agents
0
Blood Glucose
0
Banques de données
ANZCTR
['ACTRN12619000515190']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e15020Subventions
Organisme : Juvenile Diabetes Research Foundation International
Organisme : Diabetes Australia
Informations de copyright
© 2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.
Références
McAuley SA, Trawley S, Vogrin S, et al. Closed-loop insulin delivery versus sensor-augmented pump therapy in older adults with type 1 diabetes (ORACL): a randomized, crossover trial. Diabetes Care. 2022;45(2):381-390. doi:10.2337/dc21-1667
McAuley SA, Lee MH, Paldus B, et al. Six months of hybrid closed-loop versus manual insulin delivery with Fingerprick blood glucose monitoring in adults with type 1 diabetes: a randomized, controlled trial. Diabetes Care. 2020;43(12):3024-3033. doi:10.2337/dc20-1447
Abraham MB, deBock M, Smith GJ, et al. Effect of a hybrid closed-loop system on glycemic and psychosocial outcomes in children and adolescents with type 1 diabetes: a randomized clinical trial. JAMA Pediatr. 2021;175(12):1227-1235. doi:10.1001/jamapediatrics.2021.3965
Ware J, Allen JM, Boughton CK, et al. Randomized trial of closed-loop control in very young children with type 1 diabetes. N Engl J Med. 2022;386(3):209-219. doi:10.1056/NEJMoa2111673
Hood KK, Garcia-Willingham N, Hanes S, et al. Lived experience of CamAPS FX closed loop system in youth with type 1 diabetes and their parents. Diabetes Obes Metab. 2022;24:2309-2318. doi:10.1111/dom.14815
Hood KK, Laffel LM, Danne T, et al. Lived experience of advanced hybrid closed-loop versus hybrid closed-loop: patient-reported outcomes and perspectives. Diabetes Technol Ther. 2021;23(12):857-861. doi:10.1089/dia.2021.0153
Roberts A, Fried L, Dart J, et al. Hybrid closed-loop therapy with a first-generation system increases confidence and independence in diabetes management in youth with type 1 diabetes. Diabet Med. 2022;39(9):e14907. doi:10.1111/dme.14907
Lacy ME, Gilsanz P, Eng C, Beeri MS, Karter AJ, Whitmer RA. Severe hypoglycemia and cognitive function in older adults with type 1 diabetes: the study of longevity in diabetes (SOLID). Diabetes Care. 2020;43(3):541-548. doi:10.2337/dc19-0906
Sinclair AJ, Dunning T, Dhatariya K, An International Group of E. Clinical guidelines for type 1 diabetes mellitus with an emphasis on older adults: an executive summary. Diabet Med. 2020;37(1):53-70. doi:10.1111/dme.14135
Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365-1375. doi:10.1016/S0140-6736(19)31786-6
Grammes J, Kustner E, Dapp A, et al. Comparative characteristics of older people with type 1 diabetes treated with continuous subcutaneous insulin infusion or insulin injection therapy: data from the German/Austrian DPV registry. Diabet Med. 2020;37(5):856-862. doi:10.1111/dme.14218
Roem K, Compton R, Fourlanos S, McAuley SA. Carbohydrate-counting education for older adults with type 1 diabetes starting first-generation closed-loop therapy: Observations from the ORACL trial. Nutr Diet. 2022;79(5):647-649. doi:10.1111/1747-0080.12744
Trawley S, Ward GM, Vogrin S, et al. Glucose profiles of older adults with type 1 diabetes using sensor-augmented pump therapy in Australia: pre-randomisation results from the ORACL study. Lancet Healthy Longev. 2022;3(12):e839-e848. doi:10.1016/s2666-7568(22)00266-5
Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29-37. doi:10.1007/BF02982161
Katz S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc. 1983;31(12):721-727.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist Autumn. 1969;9(3):179-186.
Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699. doi:10.1111/j.1532-5415.2005.53221.x
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101. doi:10.1191/1478088706qp063oa
Iturralde E, Tanenbaum ML, Hanes SJ, et al. Expectations and attitudes of individuals with type 1 diabetes after using a hybrid closed loop system. Diabetes Educ. 2017;43(2):223-232. doi:10.1177/0145721717697244
Lawton J, Blackburn M, Rankin D, et al. Participants‘ experiences of, and views about, daytime use of a Day-and-night hybrid closed-loop system in real life settings: longitudinal qualitative study. Diabetes Technol Ther. 2019;21(3):119-127. doi:10.1089/dia.2018.0306
Boughton CK, Hartnell S, Thabit H, et al. Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study. Lancet Healthy Longev. 2022;3(3):e135-e142. doi:10.1016/S2666-7568(22)00005-8
Shah VN, Wu M, Foster N, Dhaliwal R, Al MM. Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes. Arch Osteoporos. 2018;13(1):66. doi:10.1007/s11657-018-0475-z
Boscari F, Ferretto S, Cavallin F, Bruttomesso D. Switching from predictive low glucose suspend to advanced hybrid closed loop control: effects on glucose control and patient reported outcomes. Diabetes Res Clin Pract. 2022;185:109784. doi:10.1016/j.diabres.2022.109784
Ng SM, Katkat N, Day H, Hubbard R, Quinn M, Finnigan L. Real-world prospective observational single-Centre study: hybrid closed loop improves HbA1c, time-in-range and quality of life for children, young people and their carers. Diabet Med. 2022;39(7):e14863. doi:10.1111/dme.14863
Chakrabarti A, Trawley S, Kubilay E, et al. Closed-loop insulin delivery effects on glycemia during sleep and sleep quality in older adults with type 1 diabetes: results from the ORACL trial. Diabetes Technol Ther. 2022;24(9):666-671. doi:10.1089/dia.2022.0110
Tanenbaum ML, Iturralde E, Hanes SJ, et al. Trust in hybrid closed loop among people with diabetes: perspectives of experienced system users. J Health Psychol. 2020;25(4):429-438. doi:10.1177/1359105317718615
Toschi E, Munshi MN. Benefits and challenges of diabetes technology use in older adults. Endocrinol Metab Clin North Am. 2020;49(1):57-67. doi:10.1016/j.ecl.2019.10.001
Bispham JA, Hughes AS, Fan L, Perez-Nieves M, McAuliffe-Fogarty AH. “I‘ve had an alarm set for 3:00 a.m. for decades”: the impact of type 1 diabetes on sleep. Clin Diabetes. 2021;39(2):153-159. doi:10.2337/cd20-0026
Garg SK, Kipnes M, Castorino K, et al. Accuracy and safety of Dexcom G7 continuous glucose monitoring in adults with diabetes. Diabetes Technol Ther. 2022;24(6):373-380. doi:10.1089/dia.2022.0011
Lal RA, Basina M, Maahs DM, Hood K, Buckingham B, Wilson DM. One year clinical experience of the first commercial hybrid closed-loop system. Diabetes Care. 2019;42(12):2190-2196. doi:10.2337/dc19-0855
Addala A, Suttiratana SC, Wong JJ, et al. Cost considerations for adoption of diabetes technology are pervasive: a qualitative study of persons living with type 1 diabetes and their families. Diabet Med. 2021;38(10):e14575. doi:10.1111/dme.14575
NDSS. Eligibility expansion for all people with type 1 diabetes to access subsidised CGM and flash GM products through the NDSS. Accessed 21 Oct, 2022. https://www.ndss.com.au/news/eligibility-expansion-for-all-people-with-type-1-diabetes-to-access-subsidised-cgm-and-flash-gm-products-through-the-ndss/
Seeto T. How much does private health insurance cost?https://www.canstar.com.au/health-insurance/what-does-health-insurance-cost/
Pease AJ, Andrikopoulos S, Abraham MB, et al. Utilisation, access and recommendations regarding technologies for people living with type 1 diabetes: consensus statement of the ADS/ADEA/APEG/ADIPS working group. Med J Aust. 2021;215(10):473-478. doi:10.5694/mja2.51118
Australian Prudential Regulation Authority. Quarterly private health insurance statistics. https://www.apra.gov.au/quarterly-private-health-insurance-statistics
McAuley SA, Trawley S. Closed-loop therapy in older adults with type 1 diabetes: hypoglycaemia benefits and risk stratification. Lancet Healthy Longev. 2022;3(6):e378. doi:10.1016/S2666-7568(22)00092-7
Pratley RE, Casu A. Closed-loop therapy in older adults with type 1 diabetes: hypoglycaemia benefits and risk stratification - Authors‘ reply. Lancet Healthy Longev. 2022;3(6):e379. doi:10.1016/S2666-7568(22)00112-X
Carson N, Leach L, Murphy KJ. A re-examination of Montreal cognitive assessment (MoCA) cutoff scores. Int J Geriatr Psychiatry. 2018;33(2):379-388. doi:10.1002/gps.4756