"I Think I Could Have Used It Better": Experiences of Youth with High HbA1c Commencing Advanced Hybrid Closed-Loop Therapy in a Clinical Trial Setting-A Qualitative Research.

IF 3.9 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Pediatric Diabetes Pub Date : 2024-09-03 eCollection Date: 2024-01-01 DOI:10.1155/2024/6260002

Alison Roberts, Julie Dart, Selena Lloyd, Keely Bebbington, Janice M Fairchild, Geoffrey R Ambler, Fergus J Cameron, Elizabeth A Davis, Timothy W Jones, Mary B Abraham

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引用次数: 0

Abstract

Background: Advanced hybrid closed-loop (AHCL) therapy improves glycemia. However, it is not known if there is an improvement in overall outcomes with AHCL for youth with type 1 diabetes (T1D) at high risk of diabetes-related complications. The study aimed to capture the experiences of youth with suboptimal glycemic control when commencing AHCL therapy in a clinical trial setting.

Methods: This was a singlecenter substudy of a multicenter 6-month randomized clinical trial. Youth between 12 and 25 years of age on insulin pump therapy with HbA1c > 8.5% (> 69 mmol/mol) who commenced AHCL therapy with Medtronic MiniMed™ system were invited to participate in a semistructured interview after 6 months of AHCL. Open-ended questions were used to explore the participants' lived experience of AHCL in improving their glucose levels and its impact on diabetes management and well-being. The interviews were audiorecorded, transcribed, and analyzed using thematic analysis.

Results: Ten youth with T1D with a mean (SD) age of 17.4 (2.9) years, diabetes duration 10.7 (4.8) years, HbA1c 10.2 (0.8)%, or 87 (9.5) mmol/mol at enrollment participated in the interview. Three main themes were identified: (1) improved glycemia despite not using closed loop to its full potential; (2) persistent diabetes burden; and (3) a need for increased psychosocial and clinical support. Although improved glycemia was noted with AHCL therapy, participants reported ongoing motivation issues and used the system suboptimally. They continued to experience distress with overall diabetes management and acknowledged the need for ongoing support from family and health professionals.

Conclusion: All participants reported overall satisfaction with improved glucose levels, however, the persistent diabetes burden impacted their ability to use AHCL optimally. The need for ongoing monitoring with support and interventions to enhance psychological care remains vital for youth with suboptimal diabetes management.

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“我想我本可以用得更好”：高HbA1c青年在临床试验中开始高级混合闭环治疗的经验-一项定性研究。

背景：高级混合闭环（AHCL）治疗可改善血糖。然而，目前尚不清楚AHCL是否能改善患有糖尿病相关并发症高风险的1型糖尿病（T1D）青年患者的总体预后。该研究旨在捕捉在临床试验环境中开始AHCL治疗时血糖控制不佳的年轻人的经历。方法：这是一项多中心6个月随机临床试验的单中心亚研究。接受胰岛素泵治疗且HbA1c bbbb8.5 % （bbbb69 mmol/mol）的12 - 25岁青年在AHCL治疗6个月后被邀请参加半结构化访谈。使用开放式问题来探讨AHCL对参与者改善血糖水平的生活体验及其对糖尿病管理和健康的影响。访谈录音，转录，并使用专题分析进行分析。结果：10名青年T1D患者参加了访谈，平均（SD）年龄为17.4（2.9）岁，糖尿病病程为10.7（4.8）年，HbA1c在入组时为10.2(0.8)%，或87 (9.5)mmol/mol。确定了三个主要主题：(1)血糖改善，尽管没有使用闭环发挥其全部潜力；(2)持续性糖尿病负担；(3)需要增加社会心理和临床支持。虽然AHCL治疗可以改善血糖，但参与者报告了持续的动力问题，并且不太理想地使用了该系统。他们在总体糖尿病管理中继续感到痛苦，并承认需要家庭和卫生专业人员的持续支持。结论：所有参与者都报告了血糖水平改善的总体满意度，然而，持续的糖尿病负担影响了他们最佳使用AHCL的能力。持续监测、支持和干预以加强心理护理的必要性对糖尿病管理欠佳的青年仍然至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Diabetes 医学-内分泌学与代谢

CiteScore

6.60

自引率

14.70%

发文量

141

审稿时长

4-8 weeks

期刊介绍： Pediatric Diabetes is a bi-monthly journal devoted to disseminating new knowledge relating to the epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes in childhood and adolescence. The aim of the journal is to become the leading vehicle for international dissemination of research and practice relating to diabetes in youth. Papers are considered for publication based on the rigor of scientific approach, novelty, and importance for understanding mechanisms involved in the epidemiology and etiology of this disease, especially its molecular, biochemical and physiological aspects. Work relating to the clinical presentation, course, management and outcome of diabetes, including its physical and emotional sequelae, is considered. In vitro studies using animal or human tissues, whole animal and clinical studies in humans are also considered. The journal reviews full-length papers, preliminary communications with important new information, clinical reports, and reviews of major topics. Invited editorials, commentaries, and perspectives are a regular feature. The editors, based in the USA, Europe, and Australasia, maintain regular communications to assure rapid turnaround time of submitted manuscripts.