Real-world lived experience of older adults with type 1 diabetes after an automated insulin delivery trial.

Autor: Kubilay E; Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia.; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia., Trawley S; Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia.; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia., Ward GM; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia., Fourlanos S; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.; Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Victoria, Australia., Colman PG; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia., McAuley SA; Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia.; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Diabetic medicine : a journal of the British Diabetic Association [Diabet Med] 2024 Apr; Vol. 41 (4), pp. e15264. Date of Electronic Publication: 2023 Dec 10.
DOI: 10.1111/dme.15264
Abstrakt: Aims: First-generation closed-loop automated insulin delivery improves glycaemia and psychosocial outcomes among older adults with type 1 diabetes in clinical trials. However, no study has previously assessed real-world lived experience of older adults using closed-loop therapy outside a trial environment.
Methods: Semi-structured interviews were conducted with older adults who were pre-existing insulin pump users and previously completed the OldeR Adult Closed-Loop (ORACL) randomised trial. Interviews focused on perceptions of diabetes technology use, and factors influencing decisions regarding continuation.
Results: Twenty-eight participants, mean age 70 years (SD 5), were interviewed at median 650 days (IQR 608-694) after their final ORACL trial visit. At interview, 23 participants (82%) were still using a commercial closed-loop system (requiring manual input for prandial insulin bolus doses). Themes discussed in interviews relating to closed-loop system use included sustained psychosocial benefits, cost and retirement considerations and usability frustrations relating to sensor accuracy and system alarms. Of the five participants who had discontinued, reasons included cost, continuous glucose monitoring-associated difficulties and usability frustrations. Cost was the largest consideration regarding continued use; most participants considered the increased ease of diabetes management to be worth the associated costs, though cost was prohibitive for some.
Conclusions: Almost 2 years after completing a closed-loop clinical trial, closed-loop automated insulin delivery remains the preferred type 1 diabetes therapy for the majority of older adult participants. Chronological age is not a barrier to real-world successful use of diabetes technology. Identifying age-related barriers, and solutions, to diabetes technology use among older adults is warranted.
(© 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)
Databáze: MEDLINE
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