Page 339 - Glucose Monitoring Devices

346 CHAPTER 16 The dawn of automated insulin delivery

size. Currently, an open artificial pancreas system (open APS) and loop have
garnered thousands of users. The JAEB center for health research is conducting a
study entitled, “An Observational Study of Individuals with Type 1 Diabetes Using
the Loop System for Automated Insulin Delivery.” Tidepool, a nonprofit organiza-
tion, which seeks to make diabetes data more accessible through downloads and
data reports, is working to obtain regulatory approval of the loop system.

Patient considerations
It is important to understand how hybrid closed-loop technology psychologically
affects those with T1D and if patient expectations are being met with the new tech-
nology. Although hybrid closed-loop therapy allows for the potential to decrease
diabetes burden, improve glycemic control, and as a result, reduce complications,
early studies have shown a lack of trust in the system [121]. One of the challenges
in early trials was perceived CGM inaccuracy [122,123], with person-specific
factors, including time since diagnosis and self-perception of T1D management
playing a role in this viewpoint. Prior negative experience with system components,
such as early generation sensors, made individuals in these studies less apt to want to
use a newer device from the same company. Conversely, those who were comfort-
able with their current devices were less likely to be open to trying a new device.
The degree that a user wants to engage with a hybrid closed-loop system has been
found to be a wide spectrum. Some users want more control over the hybrid closed-
loop system, with the ability to override the system frequently, find ways to work
around the system by using it incorrectly to get the result they want, or users wanted
to input more detailed information. Others may enjoy having to make fewer
decisions and think about diabetes less by allowing the system to function but
may also become deskilled and less vigilant over time [122]. Thus, creating different
types of systems that require more or less user feedback will be beneficial to meet
the needs of the individual with T1D.
To increase access and usability, hybrid closed-loop technology needs to be easy
to understand and adaptable for individuals of all education levels and available in
multiple languages. Currently, only older versions of the Medtronic pumps (530G,
paradigm revel, paradigm 522/722, paradigm 515/715) allow for languages other
than English. This poses a limitation for families who may not be comfortable
reading English on a medical device.

Conclusion
The past 40 years have seen technology integrate into how we manage type 1
diabetes, with a technological revolution currently underway. Just as the technology
we use in our personal lives has rapidly evolved, the same holds true for diabetes
devices. To date, closed-loop systems have been successful in increasing time in
the target range, albeit with the caveat of requiring a premeal bolus. Although