Experiences of closed‐loop insulin delivery among pregnant women with Type 1 diabetes. Issue 10 (21st July 2017)

• Record Type: Journal Article
• Authors: Farrington, C.; Stewart, Z. A.; Barnard, K.; Hovorka, R.; Murphy, H. R.
• Is Part Of: Diabetic medicine. Volume 34:Issue 10(2017)
• Page Start: 1461
• Page End: 1469
• Publication Date: 2017-07-21
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13406
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To explore the experiences of pregnant women with Type 1 diabetes, and the relationships between perceptions of glucose control, attitudes to technology and glycaemic responses with regard to closed‐loop insulin delivery. Methods: We recruited 16 pregnant women with Type 1 diabetes [mean ±sd age 34.1 ± 4.6 years, duration of diabetes 23.6 ± 7.2 years, baseline HbA1c 51±5 mmol/mol (6.8 ± 0.6%)] to a randomized crossover trial of sensor‐augmented pump therapy vs automated closed‐loop therapy. Questionnaires (Diabetes Technology Questionnaire, Hypoglycaemia Fear Survey) were completed before and after each intervention, with qualitative interviews at baseline and follow‐up. Results: Women described the benefits and burdens of closed‐loop systems during pregnancy. Feelings of improved glucose control, excitement and empowerment were counterbalanced by concerns about device visibility, obsessive data checking and diminished attentiveness to hyper‐ and hypoglycaemia symptoms. Responding to questionnaires, eight participants felt less worry about overnight hypoglycaemia and that diabetes 'did not run their lives'; however, five reported that closed‐loop increased time thinking about diabetes, and three felt it made sleep and preventing hyperglycaemia more problematic. Women slightly overestimated their glycaemic response to closed‐loop therapy. Most became more positive in their technology attitudes throughout pregnancy. Women with more positive technology attitudes had higher degrees of overestimation, and poorer levels of glycaemic control. Conclusions: Women displayed complex psychosocial responses to closed‐loop therapy in pregnancy. Perceptions of glycaemic response may diverge from biomedical data. What's new?: This is the first study to examine the psychosocial experiences of pregnant women with Type 1 diabetes who were using automated overnight closed‐loop systems, and the first to use mixed methods to compare women's perceptions with objective glucose control data. Our findings highlight the complexities of experience surrounding automated closed‐loop systems in pregnancy. Women described a mix of benefits and burdens, and varied in the accuracy of their perceptions of glucose control. Women with more positive technology attitudes had higher degrees of overestimation and poorer glycaemic control. To ensure appropriate and safe use of closed‐loop systems in pregnancy, clinicians should account for varying user perceptions and seek to manage expectations.