David Rankin1, Barbara Kimbell1, Janet M Allen2,3, Rachel E J Besser4,5, Charlotte K Boughton2, Fiona Campbell6, Daniela Elleri7, Julia Fuchs2,3, Atrayee Ghatak8, Tabitha Randell9, Ajay Thankamony10, Nicola Trevelyan11, Malgorzata E Wilinska2,3, Roman Hovorka2,3, Julia Lawton1. 1. Usher Institute, Medical School, University of Edinburgh, UK. 2. Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, UK. 3. Department of Paediatrics, University of Cambridge, UK. 4. NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, UK. 5. Department of Paediatrics, University of Oxford, UK. 6. St James's University Hospital, Leeds, UK. 7. Royal Hospital for Sick Children, Edinburgh, UK. 8. Alder Hey Children's NHS Foundation Trust, Liverpool, UK. 9. Nottingham Children's Hospital, UK. 10. Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, UK. 11. Southampton Children's Hospital, UK.
Abstract
BACKGROUND: Closed-loop technology may help address health disparities experienced by adolescents, who are more likely to have suboptimal glycemic control than other age groups and, because of their age, find diabetes self-management particularly challenging. The CamAPS FX closed-loop has sought to address accessibility and usability issues reported by users of previous prototype systems. It comprises small components and a smartphone app used to: announce meal-time boluses, adjust ("boost" or "ease-off") closed-loop insulin delivery, customize alarms, and review/share data. We explored how using the CamAPS FX platform influences adolescents' self-management practices and everyday lives. METHODS: Eighteen adolescents were interviewed after having ≥6 months experience using the closed-loop platform. Data were analyzed thematically. RESULTS: Participants reported feeling less burdened and shackled by diabetes because closed-loop components were easier to carry/wear, finger-pricks were not required, the smartphone app provided a discreet and less stigmatizing way of managing diabetes in public, and they were able to customize alarms. Participants also reported checking and reviewing data more regularly, because they did so when using the smartphone for other reasons. Some reported challenges in school settings where use of personal phones was restricted. Participants highlighted how self-management practices were improved because they could easily review glucose data and adjust closed-loop insulin delivery using the "boost" and "ease-off" functions. Some described how using the system resulted in them forgetting about diabetes and neglecting certain tasks. CONCLUSIONS: A closed-loop system with small components and control algorithm on a smartphone app can enhance usability and acceptability for adolescents and may help address the health-related disparities experienced by this age group. However, challenges can arise from using a medical app on a device which doubles as a smartphone. TRIAL REGISTRATION: Closed Loop From Onset in Type 1 Diabetes (CLOuD); NCT02871089; https://clinicaltrials.gov/ct2/show/NCT02871089.
BACKGROUND: Closed-loop technology may help address health disparities experienced by adolescents, who are more likely to have suboptimal glycemic control than other age groups and, because of their age, find diabetes self-management particularly challenging. The CamAPS FX closed-loop has sought to address accessibility and usability issues reported by users of previous prototype systems. It comprises small components and a smartphone app used to: announce meal-time boluses, adjust ("boost" or "ease-off") closed-loop insulin delivery, customize alarms, and review/share data. We explored how using the CamAPS FX platform influences adolescents' self-management practices and everyday lives. METHODS: Eighteen adolescents were interviewed after having ≥6 months experience using the closed-loop platform. Data were analyzed thematically. RESULTS:Participants reported feeling less burdened and shackled by diabetes because closed-loop components were easier to carry/wear, finger-pricks were not required, the smartphone app provided a discreet and less stigmatizing way of managing diabetes in public, and they were able to customize alarms. Participants also reported checking and reviewing data more regularly, because they did so when using the smartphone for other reasons. Some reported challenges in school settings where use of personal phones was restricted. Participants highlighted how self-management practices were improved because they could easily review glucose data and adjust closed-loop insulin delivery using the "boost" and "ease-off" functions. Some described how using the system resulted in them forgetting about diabetes and neglecting certain tasks. CONCLUSIONS: A closed-loop system with small components and control algorithm on a smartphone app can enhance usability and acceptability for adolescents and may help address the health-related disparities experienced by this age group. However, challenges can arise from using a medical app on a device which doubles as a smartphone. TRIAL REGISTRATION: Closed Loop From Onset in Type 1 Diabetes (CLOuD); NCT02871089; https://clinicaltrials.gov/ct2/show/NCT02871089.
Authors: Tara T M Lee; Corinne Collett; Mei-See Man; Matt Hammond; Lee Shepstone; Sara Hartnell; Eleanor Gurnell; Caroline Byrne; Eleanor M Scott; Robert S Lindsay; Damian Morris; Anna Brackenridge; Anna R Dover; Rebecca M Reynolds; Katharine F Hunt; David R McCance; Katharine Barnard-Kelly; David Rankin; Julia Lawton; Laura E Bocchino; Judy Sibayan; Craig Kollman; Malgorzata E Wilinska; Roman Hovorka; Helen R Murphy Journal: BMC Pregnancy Childbirth Date: 2022-04-05 Impact factor: 3.007