Interviews with Indigenous Māori with type 1 diabetes using open-source automated insulin delivery in the CREATE randomised trial.

IF 1.8 Q4 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes and Metabolic Disorders Pub Date : 2023-06-01 DOI:10.1007/s40200-023-01215-3

Mercedes Burnside, Tracy Haitana, Hamish Crocket, Dana Lewis, Renee Meier, Olivia Sanders, Craig Jefferies, Ann Faherty, Ryan Paul, Claire Lever, Sarah Price, Carla Frewen, Shirley Jones, Tim Gunn, Benjamin J Wheeler, Suzanne Pitama, Martin de Bock, Cameron Lacey

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Abstract

Purpose: Open-source automated insulin delivery (AID) is used by thousands of people with type 1 diabetes (T1D), but has unknown generalisability to marginalised ethnic groups. This study explored experiences of Indigenous Māori participants in the CREATE trial with use of an open-source AID system to identify enablers/barriers to health equity.

Methods: The CREATE randomised trial compared open-source AID (OpenAPS algorithm on an Android phone with a Bluetooth-connected pump) to sensor-augmented pump therapy. Kaupapa Māori Research methodology was used in this sub-study. Ten semi-structured interviews with Māori participants (5 children, 5 adults) and whānau (extended family) were completed. Interviews were recorded and transcribed, and data were analysed thematically. NVivo was used for descriptive and pattern coding.

Results: Enablers/barriers to equity aligned with four themes: access (to diabetes technologies), training/support, operation (of open-source AID), and outcomes. Participants described a sense of empowerment, and improved quality of life, wellbeing, and glycaemia. Parents felt reassured by the system's ability to control glucose, and children were granted greater independence. Participants were able to use the open-source AID system with ease to suit whānau needs, and technical problems were manageable with healthcare professional support. All participants identified structures in the health system precluding equitable utilisation of diabetes technologies for Māori.

Conclusion: Māori experienced open-source AID positively, and aspired to use this therapy; however, structural and socio-economic barriers to equity were identified. This research proposes strength-based solutions which should be considered in the redesign of diabetes services to improve health outcomes for Māori with T1D.Trial Registration: The CREATE trial, encompassing this qualitative sub-study, was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000034932p) on the 20^th January 2020.

Supplementary information: The online version contains supplementary material available at 10.1007/s40200-023-01215-3.

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在CREATE随机试验中使用开源自动胰岛素输送与土著Māori 1型糖尿病患者进行访谈。

目的:开源的自动胰岛素输送(AID)被成千上万的1型糖尿病(T1D)患者使用，但对边缘族裔群体的普遍性尚不清楚。本研究探讨了CREATE试验中土著Māori参与者的经验，使用开源AID系统来确定卫生公平的促进因素/障碍。方法:CREATE随机试验比较了开源AID(带有蓝牙连接泵的Android手机上的OpenAPS算法)和传感器增强泵治疗。本子研究采用Kaupapa Māori研究方法。对Māori参与者(5名儿童，5名成人)和whānau(大家庭)进行了10次半结构化访谈。访谈被记录下来并转录，数据被按主题分析。使用NVivo进行描述性和模式编码。结果:促进公平的因素/障碍与四个主题相一致:获得(糖尿病技术)、培训/支持、(开源AID)的运营和结果。参与者描述了一种赋权感，以及生活质量、幸福感和血糖水平的提高。家长们对该系统控制血糖的能力感到放心，孩子们也被赋予了更大的独立性。与会者能够轻松地使用开源的艾滋病援助系统，以满足whānau的需要，并且在医疗保健专业人员的支持下，技术问题得到了管理。所有与会者都确定了卫生系统中妨碍公平利用Māori糖尿病技术的结构。结论:Māori积极体验开源AID，并渴望使用该疗法;但是，确定了妨碍公平的结构和社会经济障碍。本研究提出了基于力量的解决方案，应在糖尿病服务的重新设计中加以考虑，以改善Māori与T1D的健康结果。试验注册:CREATE试验，包括该定性子研究，于2020年1月20日在澳大利亚新西兰临床试验注册中心(ACTRN12620000034932p)注册。补充资料:在线版本提供补充资料，网址为10.1007/s40200-023-01215-3。

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来源期刊

Journal of Diabetes and Metabolic Disorders Medicine-Internal Medicine

CiteScore

4.80

自引率

3.60%

发文量

210

期刊介绍： Journal of Diabetes & Metabolic Disorders is a peer reviewed journal which publishes original clinical and translational articles and reviews in the field of endocrinology and provides a forum of debate of the highest quality on these issues. Topics of interest include, but are not limited to, diabetes, lipid disorders, metabolic disorders, osteoporosis, interdisciplinary practices in endocrinology, cardiovascular and metabolic risk, aging research, obesity, traditional medicine, pychosomatic research, behavioral medicine, ethics and evidence-based practices.As of Jan 2018 the journal is published by Springer as a hybrid journal with no article processing charges. All articles published before 2018 are available free of charge on springerlink.Unofficial 2017 2-year Impact Factor: 1.816.