medwireNews: The use of the Cambridge hybrid closed-loop insulin delivery system by older adults with type 1 diabetes mellitus (T1DM) is associated with “improved quality of life,” says an international team of researchers.
Kory Hood (Stanford University School of Medicine, California, USA) and collaborators compared the effects of the CamAPS FX hybrid closed-loop system with a sensor-augmented pump and found that several patient-reported outcomes (PROs) were improved.
“The participants experienced less diabetes distress and increased satisfaction in how they manage their diabetes,” report Hood et al in Diabetic Medicine.
They add that these findings are “compelling” since they build on the glycemic benefit that has already been reported with the hybrid closed-loop system from the same study.
Indeed, in the open-label, multicenter study that enrolled 38 participants, the hybrid closed-loop system was associated with greater time in range than with a sensor-augmented pump and improved nighttime glycemic control.
During the trial, the participants – who were all aged 60 years or older – underwent two 16-week periods where they used either the hybrid closed-loop system or a sensor-augmented pump, and then crossed over to use the other approach.
The PROs analysis included 35 patients who completed the Diabetes Distress Scale (DDS) and Glucose Monitoring Satisfaction Survey (GMSS) at the start of the study and again at the end of each treatment period, with 19 participating in interviews about using the hybrid closed-loop system.
Overall scores on the DSS before and after using the hybrid closed-loop system were 1.54 and 1.43, respectively, which indicated a significant improvement.
There was also significant improvement on two subscales of the DSS. Scores for the powerlessness subscale, which measures levels of discouragement about diabetes, decreased from 2.01 before to 1.82 after use of the hybrid closed-loop system.
And scores on the physician distress subscale, which gives a measure of how satisfied people are with their current healthcare provider, improved from 1.14 before to 1.02 after use of the hybrid closed-loop system.
Levels of trust, a subscale of the GMSS, also significantly improved with use of the hybrid closed-loop system, decreasing from a high of 2.55 before use suggesting lower trust to 2.07 after use indicating greater trust.
Results of the user experience interviews, which were performed by a psychologist at the end of the main study, were similarly positive. All but one of those interviewed (95%) said they would like to continue using the hybrid closed-loop system if it was offered to them. In addition, almost two thirds of the interviewees felt that the hybrid closed-loop system reduced their mental and emotional stress.
However, some interviewees did express difficulty with using the insulin pump due to its small size and others noted potential problems with the algorithm used to deliver insulin during times of moderate to intense exercise and subsequent hypoglycemia.
“In this sample of older adults with T1D who have previously shown glycaemic benefit, there are indicators of improved PROs and subjective user experience benefits,” Hood and team report.
“The results are promising and future work with larger samples, or through commercial use of the CamAPS FX system, will provide more confidence in these findings.”
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