Experiences of adolescents and young adults with type 1 diabetes and chronically elevated glucose levels following the transition from multiple daily injections to advanced hybrid closed-loop: A qualitative study

IF 3.2 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Jessica Y. Wong, Sara E. Styles, Esko J. Wiltshire, Martin I. de Bock, Alisa Boucsein, Octavia J. Palmer, Benjamin J. Wheeler
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Abstract

Aim

To understand experiences of using second-generation advanced hybrid closed-loop (AHCL) therapy in adolescents and young adults with chronically elevated glucose levels who were previously using multiple daily injections (MDI) therapy.

Method

Semi-structured interviews with participants aged 13–25 years, on AHCL therapy for 3 months as part of a single-arm prospective study. Key inclusions: HbA1c ≥69 mmol/mol (8.5%); diabetes duration ≥1 year; and using MDI therapy prior to the study. Qualitative content analysis was used to identify themes and subthemes.

Results

Interviews were conducted among 14 participants with mean age 19.4 ± 4.3 years and mean baseline HbA1c 90 ± 25 mmol/mol (10.4 ± 4.5%). Three themes were identified: (1) substantially improved glucose levels improved perceptions of overall health; (2) features of AHCL aid in adoption and ongoing self-management; and (3) burden of care was reduced through automation of insulin delivery. Overall, there were positive impacts on physical, mental and social well-being. Participants were willing to overlook minor frustrations with AHCL because of the vast benefits that they had experienced. Four participants reported transient pseudo-hypoglycaemia: symptoms of hypoglycaemia when objectively measured glucose was in the clinically recommended range (3.9–10 mmol/L, 70–180 mg/dL).

Conclusion

Transition to AHCL therapy positively impacted diabetes management in adolescents and youth with chronically elevated glucose levels. It appears to create a window of opportunity in which youth may re-engage with diabetes management. Pseudo-hypoglycaemia can occur during the transition to AHCL. This could be a barrier to AHCL uptake and is likely to require individualised support.

患有 1 型糖尿病且血糖水平长期升高的青少年从每日多次注射过渡到高级混合闭环疗法后的经历:定性研究。
目的:了解曾使用每日多次注射(MDI)疗法、血糖水平长期升高的青少年使用第二代高级混合闭环疗法(AHCL)的经验:作为单臂前瞻性研究的一部分,对 13-25 岁、接受 AHCL 治疗 3 个月的参与者进行半结构式访谈。主要结论HbA1c≥69毫摩尔/摩尔(8.5%);糖尿病病程≥1年;研究前使用过MDI疗法。采用定性内容分析法确定主题和次主题:对 14 名参与者进行了访谈,他们的平均年龄为 19.4 ± 4.3 岁,平均基线 HbA1c 为 90 ± 25 mmol/mol(10.4 ± 4.5%)。确定了三个主题:(1)血糖水平显著改善,提高了对整体健康的认识;(2)AHCL 的特点有助于采用和持续的自我管理;(3)胰岛素给药自动化减轻了护理负担。总之,对身体、精神和社会福祉都产生了积极影响。由于体验到了AHCL带来的巨大益处,参与者愿意忽略AHCL带来的小挫折。四名参与者报告了短暂的假性低血糖:当客观测量的血糖处于临床推荐范围(3.9-10 毫摩尔/升,70-180 毫克/分升)时出现低血糖症状:结论:过渡到 AHCL 治疗对长期血糖升高的青少年的糖尿病管理有积极影响。这似乎为青少年重新参与糖尿病管理创造了机会。在向 AHCL 过渡期间,可能会出现假性高血糖。这可能会阻碍AHCL的使用,并可能需要个性化的支持。
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来源期刊
Diabetic Medicine
Diabetic Medicine 医学-内分泌学与代谢
CiteScore
7.20
自引率
5.70%
发文量
229
审稿时长
3-6 weeks
期刊介绍: Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”
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